History and Physical Examination of the Neonate

CHAPTER 3 History and Physical Examination of the Neonate

In this chapter, the neonatal period is defined as the period from birth through 3 weeks of age, or when the puppy or kitten is walking and capable of spontaneous urination and defecation. Box 3-1 contains a general overview of important parameters in the physical examination of neonatal dogs and cats.

Collecting a Comprehensive History

Although clients with a sick puppy or kitten often resent the time taken by a technician or veterinarian to ask historical questions, collection of a relevant history leads the veterinarian’s physical examination and any further diagnostic testing and may alter plans for therapy. If a significant number of pediatric patients are seen in a practice, it may be beneficial to use the following history questions to create a history template that can be filled out (either as a hard copy or electronically) as puppies and kittens are admitted to the practice.

Colostrum Ingestion

Kittens may receive as much as 25% of their maternally derived antibodies through the placenta; puppies receive 5% to 10% at best. Because of this minimal antibody transfer across the endotheliochorial placenta of bitches and queens, ingestion of colostrum is necessary for the bulk of passive transfer. Puppies and kittens should be encouraged to nurse within hours of birth. Maximal absorption of antibodies through the gastrointestinal (GI) tract occurs at about 8 hours of life, with virtually no GI uptake of antibodies by 1 day of life. In puppies, if the owner is unsure whether or not a given pup has nursed and is sure another has nursed, blood can be drawn from both and serum alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) values compared between the two. Concentrations are higher in pups that have ingested colostrum and remain high for only 1 to 2 days after ingestion. If a neonate is known not to have ingested colostrum, antibodies can be provided by administration of serum or plasma from any vaccinated adult of the same species, given orally (within the first day of life) or as subcutaneous boluses. The empirical regimen for kittens is administration of 15 ml of serum pooled from several adults (mindful of blood type to prevent neonatal isoerythrolysis), given as 3 boluses, administered at birth, and 12 and 24 hours later. The empirical regimen for puppies is administration of 10 ml/lb (22 ml/kg) of pooled adult serum; this can be given at once in large pups or split into boluses as described for kittens.

Birth Weight and Changes in Body Weight

Low birth weight is correlated with poor survivability. Normal birth weight for kittens is about 100 gm (3.5 oz). Normal birth weight for puppies varies by breed, with general averages of 120 gm (4.2 oz) for toy breed pups, 250 gm (9 oz) for medium breed pups, 490 gm (17 oz) for large breed pups, and 625 gm (22 oz) for giant breed pups. Low birth weight also may be an indicator of an abnormality of the dam, for example, hypothyroidism in bitches.

Puppies and kittens may lose a small amount of weight in the first 24 hours of life because they dehydrate slightly and defecate for the first time. Puppies and kittens should gain weight daily, doubling birth weight by 7 to 10 days of age. It has been demonstrated that those pups that lose more than 10% of their birth weight within the first 2 days of life were much less likely to survive to weaning than those that maintain or gain weight in that time. It is recommended that all neonates be weighed at birth, at 12 and 24 hours of life, and daily thereafter, with good records maintained to document changes in body weight. Any loss of weight after 1 day of age should be a signal to have that neonate seen by a veterinarian; weight loss may precede onset of recognizable signs of disease by as much as 16 hours.

Body weight can be used to estimate age of healthy kittens. Most kittens gain weight in a fairly linear fashion so that they weigh about 1 lb at 1 month of age, about 2 lb at 2 months, and so on until reaching adult weight at about 6 months of age.

Physical Examination

The timing of significant events in pediatric development can be found in Table 3-1.

TABLE 3-1 Timing of significant events in pediatric development

Event Age at occurrence
Umbilical cord dries and falls off 2-3 days
Eyelids open 5-14 days
External ear canals open 6-14 days
Extensor dominance 5 days
Capable of crawling 7-14 days
Capable of walking, urinating, and defecating spontaneously 14-21 days
Hematocrit/RBC number stabilize near that of adult 8 weeks
Renal function nears that of adult 8 weeks
Hepatic function nears that of adult 4-5 months

RBC, Red blood cell.

Apgar Scoring

Human neonates are scored for various viability measures at birth. The scoring system used was developed by Virginia Apgar, MD, and bears her name. A similar scoring system has been proposed for neonatal dogs and cats (Table 3-2). At present, there are no studies correlating viability scores at birth with morbidity or mortality in puppies or kittens. This system may be most useful as a way of consistently reevaluating an ill puppy or kitten during hospitalization or if they are presented repeatedly. This system provides an objective measure for the medical record for this individual and may be used to guide urgency of diagnostics or alterations in treatment by the veterinary staff.

Hydration Status

Hydration status can be difficult to assess in neonatal puppies and kittens. Skin turgor or tenting is not as accurate an indicator of hydration status in pediatric animals as it is in adult animals because neonates have less subcutaneous fat. Well-hydrated puppies and kittens with light pigmentation normally have fairly deep pink coloration of the ventrum, muzzle, and oral mucous membranes (Figure 3-1). There is deepening to dark pink or red with dehydration, but this is a very subjective measure. Oral and ocular mucous membranes may be dry in dehydrated animals. Caution should be used when assessing oral mucous membranes in animals that have recently nursed; milk on the mucous membranes will make them feel slick, artifactually suggesting normal hydration. Normal urine in neonatal animals is very dilute with no discernible color. Stimulation of urination by gentle manipulation of the genitalia with a moistened cotton ball allows one to assess color of urine; any yellow color suggests dehydration is present. Packed cell volume (PCV) cannot be used as a measure of hydration in neonatal puppies and kittens because there is variation in the number of red blood cells (RBCs) passed through the placenta and umbilicus at the time of parturition and because there is a normal decline in PCV with age until it stabilizes at about 8 weeks of age.

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Sep 11, 2016 | Posted by in SMALL ANIMAL | Comments Off on History and Physical Examination of the Neonate

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