41 Notes on paediatric medicine
The Healthy Neonate
• Inadequate milk intake usually results in constant crying, failure to gain weight, and reluctance to nurse; supplemental feeding or a healthy vaccinated foster dam may be required.
Physical examination
Approximate normal physiological parameters are shown in Table 41.1. Healthy neonates are lively and plump. An estimation of general health and physical condition can be made by assessing the following:
• Righting reflex when placed in dorsal recumbency: present at birth and strengthens over the first 4 weeks
Table 41.1 Approximate guidelines for physiological parameters in neonatal puppies and kittens
| Physiological parameter | Normal values or findings |
|---|---|
| Heart rate | Puppies: 180–200 beats per minute; kittens: 250 beats per minute; decreases from 4 weeks old |
| Respiratory rate | 20–30 breaths per minute |
| Rectal temperature | Average 36.0°C at birth; adult values by 4 weeks old |
| Mean arterial blood pressure | Considerably lower than adults; may not normalize until several months of age |
| Opening of eyes | Usually by 14 days old (5–14 days) |
| Vision | Usually normal by 3–4 weeks old |
| Menace response | May take 2–3 months to develop but can be sooner |
| Pupillary light reflexes | Present when eyes first open; normal by 3 weeks old |
| Opening of ear canals | Usually 6–14 days old |
| Hearing | Mature by 3–4 weeks old |
| Olfaction | Well developed at birth |
| Pain sensation | Present at birth |
| Withdrawal reflex | Usually develops by 1 week old |
| Ambulation | Usually develops by 2–3 weeks old |
| Gag reflex | Usually not present until after 10 days old |
Specific problems to examine neonates for include:
• Umbilical infection: the umbilical cord usually falls off by 3 days of age and the umbilicus should be dry. A soft erythematous umbilicus, possibly with a discharge, is suggestive of bacterial omphalitis
• Open fontanelle: may be associated with fading or future neurological signs. Many toy canine breeds have open fontanelles and small open fontanelles may be normal in kittens
• Protruding eyelids: ophthalmia neonatorum may cause protrusion of the eyelids before they are fully open, with or without a purulent discharge; due to infection with Staphylococcus sp or other normal flora
Body weight
Weight gain
Approximate guidelines for daily weight gain:
• Puppies should gain 2.2–2.7 g for every kg of anticipated adult weight each day, or have a daily weight gain of 5–10% of their birth weight. Healthy puppies usually will have doubled their birth weight by 10 days of age.
• Kittens should gain a minimum of 7–10 g per day (can be as much as 15–30 g) and healthy kittens usually will have doubled their birth weight by 14 days of age.
Urination and defecation
• Unable to urinate voluntarily for the first 2–3 weeks of life; urination stimulated by maternal licking of the genital region.
• Can only defecate when stimulated by maternal licking of anal region:
– Faeces then become light to medium brown in colour and pasty in consistency; typically they do not become solid until after weaning
Clinical Tip
• Neonates require maternal licking of the genital and anal regions in order to urinate and defecate, and this is potentially readily overlooked if neonates are hospitalized away from the dam. In such cases the genital and anal regions can be stimulated by gentle stroking for example with a warm moist cotton wool ball.
Clinical Pathology
Clinical Tip
• Venepuncture in neonates is usually performed using a jugular vein and the author would strongly encourage the prior application of EMLA® cream 5% (AstraZeneca) (see Ch. 5). Both the difficulties in obtaining samples and especially the small blood volume of these animals mean that it is absolutely crucial to plan tests carefully so as to coordinate interventions, to take the minimum volume of blood required, and to run only tests that are essential. Maximum use should be made of any blood taken and chemistry analysers that only require low volume samples should be used as much as possible. In addition, peripheral blood smear examination is usually more than adequate and uses much less blood than performing a full haematology profile.
• At least in the context of clinical pathology that requires blood sampling, it is an unavoidable reality that neonates are unlikely to receive as intensive investigation or monitoring as an older animal. This needs to be accepted and embraced from the outset and does not preclude these patients from nevertheless receiving excellent care. Common sense is very much needed so that for example empirical glucose supplementation may be provided to sick neonates as they are prone to hypoglycaemia rather than performing frequent venepuncture for blood glucose measurement.
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