Neonatology Flashcards
(217 cards)
1
Q
Describe a healthy neonate
A
eats and sleeps
strong suckle reflex
full, soft abdomen
gains weight daily
dry and clean umbilicus
transparent urine
yellow, pasty feces
no nasal or ocular discharge
good body tone
no congenital defects
2
Q
A puppy’s body temp increases within the first ______ weeks of life. It starts at 95-99 and raises to 99-101. For this fact, we must provide a heat source and adequate humidity during the neonatal period.
A
4
3
Q
what are the 5 parameters of Apgar viability scoring (test that is performed 60-120 minutes after birth)?
A
- activity, muscle tone
- pulse, HR
- reflexes when stressed
- MM color
- respiratory rate
4
Q
In regard to the Apgar viability score, what score indicates a weak vitality?
Moderate vitality?
Normal vitality?
A
weak = 0-3 total points
moderate = 4-6 total points
normal = 7-10 total points
5
Q
Midline defects, atresia ani, polydactylia, hydrocephalus, and anascara are all …
A
common congenital abnormalities in neonates
6
Q
If neonatal reflexes are strong, describe how the following would be:
nursing
rooting
righting
A
nursing – when you insert your finger into their mouth, they should suckle strongly
rooting – circle thumb and forefinger around muzzle and they should attempt to find and suckle
righting – place the puppy on its back and it should get back into upright position
7
Q
A healthy/normal neonatal puppy and kittens HR should be?
A
pup = 200 bpm
kitten = 220-250 bpm
8
Q
a healthy/normal respiratory rate for neonatal pup and kitten should be?
What RR is considered pathologic?
A
pup = 10-18 (day 1), 15-35 (week 1)
kitten = 15-35
pathologic = >40 bpm
9
Q
Weight is the best way to assess health and normal condition in neonates. You should weigh them 1-2x/day. A puppy should gain ______/day and a kitten should gain _______/day.
A
pup = 5-10% / day until 5 months
kitten = 10-15 grams/day(450g by 1 month, 900g by 2 months)
10
Q
the umbilical cord should dry and fall off within ___ days post birth in SA.
A
2-3
11
Q
the extensor dominance should take place within _____ days post birth in SA
A
5 days
12
Q
eyes and ears open around ____ weeks post birth
A
2
13
Q
walking, urinating, defecating spontaneously (without assistance from dam) in SA occurs ______ weeks post birth.
A
2-3
14
Q
teeth eruption in SA occurs ____ weeks post birth
A
5-6
15
Q
________ is the major source of passive immune transfer in small animals. 25% in kittens and 5-10%.
A
colostrum
16
Q
kittens and puppies should receive colostrum within ____ hrs of birth before intestinal closure.
A
16-24 hr
17
Q
If neonates cannot get colostrum, what is the next best source of passive transfer?
A
serum IgG within 8-12 hours (PO) or if after 8-12 hours (SQ) but it does not replace colostrum.
18
Q
You just diagnosed this lady’s cat with neonatal isoerythrolysis. She asks you to explain the cause of this condition to her, what would you say?
A
incompatability between B blood type and A or AB blood type (ie. type B queen was bred to type A or type AB tom)
anti-A alloantibodies in colostrum will destroy RBCs of kittens and cause sudden death, icterus, hemoglobinuria, anemia, tachycardia, tachypnea, and death.
19
Q
You are presented with a newborn british shorthair cat that is icteric, has tachycardia, and tachypnea. After performing blood work and seeing results that include hemoglobinuria and anemia, you diagnose this cat with neonatal isoerythrolysis. What is the treatment protocol?
A
separate the kittens from dam for 24-48 hrs (to avoid colostrum intake) and use supplemental feed or surrogate, ensuring you provide a source of IgG
blood transfusion if severe.
20
Q
how can you prevent neonatal isoerythrolysis in exotic cat breeds?
A
only breed type B queens to type B toms
21
Q
what does the weaning process look like in small animals
A
gruel – 3-4 weeks
weaning complete at 6-8 weeks
puppy food or all life stages
22
Q
Neonatal puppies up to 8 weeks of age commonly have heart murmurs and/or bradycardia. What is the cause of this?
A
their cardiovascular system does not mature until 8 weeks of age. Immature regulatory mechanisms and decreased cardiac contractility lead to hypoxia and murmurs.
23
Q
Neonatal small animals have a sterile GI tract at birth that begins to colonize within the first few days. Their defense against infection is low due to what factor?
A
they have higher gastric pH and decreased gastric emptying and motility
24
Q
The SA neonate liver is immature and has decreased gluconeogenesis and glucose storage, decreased albumin and protein synthesis, and decreased drug metabolism. At what age does the liver mature?
A
4-5 months
25
The SA neonate kidney is immature until about 9-11 weeks of age. What are the consequences of an immature kidney during the period before that?
decreased urine concentrating ability -- lower USG
decreased glomerular and tubular secretion
decreased renal clearance (medications)
26
Why do neonatal SA need IgG?
their immune systems are immature
27
at what age does thermoregulation in SA neonates mature?
>4 weeks
28
T/F: when doing blood work on neonates, you can use adult reference values for the neonatal patients
false -- they have different reference values.
29
what is a typical USG for a SA neonate? UPC ratio?
1.006-1.017
increased UPC ratio
and its normal for them to have proteinuria and glucosuria for up to 3 weeks
30
When feeding milk replacer to ophaned, sick, or hospitalized SA neonates, you must...
use specially formulated puppy and kitten milk replacer, follow prep and storage instructions, use clean utensils, and use orogastric tube or bottle to feed.
31
what are indications for orogastric tube instead of bottle to feed a neonate?
cleft palate -- to reduce aspiration risk
weak neonates - no suckling reflex
32
What must a neonates temperature be before you can attempt to feed them via orogastric tube or bottle?
>96 F
33
what is the max stomach capacity of a SA neonate?
4 mL / 100 g
be sure not to overfeed them
34
An owner found a 2 week old kitten and is planning to bottle feed. They call to ask you the amount they should feed and the frequency. What would you tell them?
2-3 mL / 100g / feeding
if 0-2 weeks --> feed every 2 hours
once 2-4 weeks --> feed every 3-6 hours
if they are gaining well, you can do a night break
35
describe a sick SA neonate
cries
weak or absent suckling reflex
insufficient or no weight gain, or weight loss
apathic, flaccid, no body tone
hypothermic
diarrhea, vomiting
dyspnea
rejected by the dam
36
SA neonates have no thermoregulation until 4-6 weeks of age which puts them at higher risk for hypothermia. This is because they have: (choose one for each)
- increased temperature loss d/t (small/large) body surface area to body mass ratio
- (small/large) body fat
- lots of body water
- low blood flow to extremities.
large body surface area to body mass ratio
small amount of body fat
37
What are the clinical signs of hypothermia in SA neonates?
decreased activity
bradycardia* --> hypoxia
anorexia
hypoglycemia (from not eating)
paralytic ileus, bloat, aspiration pneumonia
decreased nursing reflex
pale MM, coma
38
You have a 2 day old puppy in your clinic because its not doing well, likely due to being hypothermic. You take its temp and it reads 95. What can you do to resolve the hypothermia?
warm up SLOWLY (1 degree/hr)
use incubator, warming pad, heat lamps, etc.
careful not to burn!
feed warm milk once temp > 96 F
give warm fluids
39
SA neonates have immature glucose regulatory function for 10 days post-parturition. They will experience bradycardia, hypothermia, decreased suckling reflex, and anorexia as a result of developing __________.
hypoglycemia
40
How should you treat hypoglycemia in SA neonates?
1. dextrose/glucose bolus (IV or IO)
2. dextrose/glucose on gums (if circulation good and not too weak)
3. regular feeding every 2 hours*
41
Why/how do SA neonates develop hypovolemia?
their compensatory mechanisms to circulatory changes/fluid homeostasis are not mature until 8 weeks of age. they have decreased cardiovascular responses and cannot increase their HR, they have decreased contractility of their heart, and immature autonomous innervation of the heart.
AND
renal concentrating ability is immature (tubular function and GFR is lower, so renal clearance is decreased) this does not mature until 9-11 weeks
42
You have a 4 day old puppy in your clinic that is unwell and has dark yellow urine. You tell the owner that this puppy is hypovolemic. What is your treatment plan for this puppy?
isotonic fluids -- IV, IO, or SQ
do shock bolus (30-40 ml/kg)
maintenance (3-4 ml/kg/hr)
feed -- orogastric tube or bottle
monitor BW, urine output, urine color, USG, and MM
43
what are the 3 possible areas to do intraosseous catheter palcement?
1. trochanteric fossa of femur**
2. tuberositas tibiae
3. greater tubercle of humerus
44
Which period is neonatal mortality highest?
during the first week of life
(~50% puppies die within first week)
45
what are the risk factors of neonatal mortality before 1-2 days?
1. low birth weight
2. low apgar score (<6)
3. low colostrum intake and blood IgG
4. low growth rate
46
what are common infectious causes of neonatal mortality in puppies?
1. parvovirus
2. distemper virus
3. adenovirus
4. herpesvirus
5. septicemia (E. coli, klebsiella, proteus, strep., staph.)
6. respiratory: viral, bordetella, mycoplasma
47
what are the common infectious causes of neonatal mortality in kittens?
1. panleukopenia (parvo) virus
2. calicivirus
3. herpesvirus
4. leukemia virus
5. immunodeficiency virus
6. coronavirus
7. septicemia (pasteurella, strep, e coli)
8. respiratory: viral, chlamydia
48
What is the most common cause of a 'fading puppy'?
infectious* often due to sepsis
49
Maternal infection, contaminated environment, inappropriate feeding and husbandry, and stress are all predisposing factors for what?
fading puppy
50
what are the clinical signs of a fading puppy?
crying, anorexia, weak, hypothermic
pale or hyperemic MM, necrotic extremities (hypoxia, vasculitis)
dyspnea, vomiting, diarrhea, painful abdomen, hematuria
sudden death
51
how do you diagnose a 'fading puppy'?
physical exam
bloodwork (remember, you can only collect 1 mL/100g/week)
UA with c/s (esp. if you suspect septicemia)
necropsy*
52
how do you treat a 'fading puppy'?
aggressive therapy!
antibiotics -- IV, IO, or PO (amoxi-clav or other beta lactams, cephalosporins), then based on c/s
fluids -- IV, IO, or SQ
symptomatic therapy -- dextrose, feeding, warm
53
what is the deworming protocol for SA neonates and the dam?
deworm starting at 2 weeks of age and then every 2 weeks until you start year-round prevention
fecal testing should occur 4x/year in puppies
54
what is the heartworm and flea/tick prevention protocol for SA neonates and the dam?
start no later than 8 weeks, give year round
55
what dewormer is used in SA neonates?
pyrantel pamoate
56
Why are the first few minutes/hours after birth considered a "profound adaptive period" for a neonate?
Because all of their systems are transitioning from being in a protected intrauterine environment to the harsh, external environment
57
T/F: the fetal neurologic system is fully developed in large animals
true -- they are precocial species meaning that they must be born ready to live.
58
How is the fetus of a precocial species able to maintain a "sleeping" state in-utero even though their neurologic system is completely developed?
physical factors -- warmth, bouyancy
chemical factors -- inhibitory neurosteroids
59
In utero, the lungs are collapsed and fluid-filled. During birth, the thorax undergoes compression when passing through the birth canal. Rupture of the umbilical cord leads to what 2 things that stimulate respiration?
*bonus if you can say which of the 2 things is actually most important for respiration*
1. hypoxia
2. hypercarbia ** most impt
60
When the lungs inflate, _______ contributes to clearance of the airway fluid and maintainence of lung inflation
surfactant
61
Increased oxygenation during birth leads to decreased ___________.
vascular resistance
62
Pulmonary vascular resistance decreases shortly after birth which leads to increased pulmonary blood flow. When this occurs, right-sided intracardiac pressure decreases, but left-sided increases. What does this result in?
closure of the fetal bypass structures (foramen ovale and ductus arteriosus) and blood no longer being shunted from right to left.
The entire cardiac output will goes through the lungs to be oxygenated.
63
Activation of _______ in foals happens about 5 days before birth. Fetal cortisol rises as a result and continues to rise after birth before decreasing to normal values by ~1 day of age.
Hypothalamic-pituitary-adrenal axis (HPA axis)
64
Would you expect a mare who has placentitis and delivers her foal prematurely to have a vital foal?
Yes, the placentitis provided a source of "stress" to the fetus, which helped in the development of the HPA axis.
65
You are called to a farm to examine a pregnant mare who has colic symptoms. You have to deliver this foal prematurely because her due date isnt until next week. Do you expect this foal to live? Why/Why not?
No, this foal will be born premature and there was no stress that could "mature" the fetus in-utero like in cases of placentitis, etc. This fetuses HPA axis would not be mature.
66
In-utero, the fetus gets its glucose from the placenta (maternal source), but after they are born, nutrient intake becomes intermittent. They have relatively limited energy reserves of both glycogen and fat, so its not uncommon for them to develop what condition?
hypoglycemia
67
During the 1st 12-24 hours after birth of a LA neonate, the small intestine remains permeable to _____________.
macromolecules (immunoglobulins)
68
Separation and sealing of the ___________ takes place at birth. It can be normal to have small leaks, but it is considered abnormal if this structure becomes patent again later after secondary infection or inflammation.
umbilical stalk
69
The ________ are pretty quiescent in-utero, however after birth, the elimination of waste and retention of water and electrolytes by this organ becomes critical.
kidney
70
What 3 factors make thermoregulation challenging for a neonatal foal?
1. wet hair coat
2. large surface area to body mass ratio
3. minimal stores of fat or glycogen
71
Neonatal foals rely on __________ and behavioral approaches (snuggling mom, seeking less drafty areas, and nestling into straw) for thermoregulation.
shivering thermogenesis
72
If a foal is born with cranial nerve abnormalities, what is your first concern?
they will have impaired nursing activity
nursing requires successful standing AND intact cranial nerves (II, V, VII, IX, X, XI, XII) as well as an intact cerebrum for awareness.
73
Neonatal foals will stand within 1 hour of birth and should nurse unassisted within ____ of standing. They should have their first bowel movement 3 hours post birth.
1 hour post-standing / 2 hr post birth
74
T/F: a draft horse will require more time to stand post-birth
true
75
A neonatal foal should be rapidly responsive to manual stimulation post birth. They should be responsive to visual stimulation by _____ minutes and auditory stimuli by ____ mins.
20-30
40
76
Neonatal foals should be attempting to stand within ___ min of birth and standing within ____ min post birth. After this time frame, they should gain rapid improvement in coordination
30
60-120
77
What is a normal temperature for a neonatal foal?
99-101.8
78
How does a neonatal foals heart rate change post birth?
initial bradycardia (60-80 bpm)
then tachycardia (150-175 bpm)
then once they are a day old, 80-100 bpm
79
How does a foals respiration change during the neonatal period?
immediately post birth, foal will be gasping
then the RR will go to 50-75 for 20-30 minutes
then 30-40 bpm during the first 2 days
80
What is considered a "premature" foal?
born less than 320 days
normal gestation = 334-344
81
Describe the physical appearance of a premature or dysmature foal.
small body size + low birth weight
rounded forehead
silky haircoat
floppy ears
entropion
flexor and articular laxity
incomplete ossification
generalized weakness
impaired physiological responses
82
why is identification of a sick foal SO important?
1. ensure you are picking appropriate treatment
2. determine prognosis prior to treatment
3. foals deteriorate rapidly even if they are normal at birth
4. delay in treatment may worsen severity of disease or the prognosis.
83
History of placentitis, prenatal vulvar discharge, premature or delayed parturition, induced parturition, maternal illness, recent medical or sugical event, premature lactaction or agalactia, recent transport, or history of previous NI, septic foal, or dystocia are ALL ...
MATERNAL risk factors for having a sick foal
84
List some peripartum risk factors for having a sick foal
dystocia
c-section
premature/dysmature
twins
meconium staining
death of dam
FPT
failure of foal to stand and nurse within 2-3 hrs
85
Name 4 environmental risk factors for having a sick foal
1. foal in cold or wet conditions
2. foal in contaminated conditions
3. infectious disease on the farm
4. disruption of foaling process
86
If only one risk factor is identified in a equine case, what risk categorization is this?
medium
87
You are concerned that an equine patient of yours has failure of passive transport. What test can you run to confirm this and what values would indicate Partial vs complete failure of passive transfer?
test = enzyme immunoassay test (SNAP test)
adequate = IgG > 800 mg/dL
partial failure = 400-800 mg/dL
complete failure = <400 mg/dL
88
If you do not have access to SNAP tests for determining if your LA patient has passive transfer, what other values can you look at?
Chemistry --
1. serum total protein concentration -- (<5.2 g/dL)
2. serum total globulin concentration -- (<2.3 g/dL means IgG is <400; <2.7 g/dL means IgG is <800)
3. serum GGT concentration -- only in carnivores and calves
89
Your equine patient has been identified as being "high risk", what does your clinical approach look like?
1. thorough clinical exam
2. determine serum IgG +/- serial monitoring
3. frequent monitoring for any clinical deterioration or failure to progress
4. CBC/chem
5. determine if antimicrobial therapy or more intensive care is indicated
90
What is a normal birth weight for llama? alpaca?
llama = 9-18 kg
alpaca = 5-10 kg
91
What is the normal HR for an neonatal camelid?
60-90 bpm
92
What is the normal RR for an neonatal camelid?
10-30 brpm
93
What is the normal temp for a neonatal camelid?
100-102
94
Normal Crias should attempt to stand within ____ minutes post birth and attempt to nurse ____ hours post birth.
15-30 minutes
2 hours
95
Weight gain and _____ are the primary signs that clients can use to determine health of a cria
activity
96
A Premature cria is born less than _____ days gestation in the fall and ______ in the spring.
fall -- 335
spring -- 350-360
97
What are physicals signs of a premature or dysmature neonatal cria?
obtundation
low birth weight
unerupted incisors
floppy ears
poor/absent suckle reflex
silky haircoat
98
T/F: Crias are typically born in the hours between 12a-6a. Crias born outside of this timeframe often have problems and are considered high risk
false -- they are born between 6am-12 pm (daytime) due to coldness at night. this is opposite from foals, who are in fact born between 12a-6a (night)
99
Failure of passive transfer is a major cause of mortality in neonatal camelids. The gold standard test is radial-immunodiffusion (RID), however this test takes 24 hours for results to come back, so its not practical in these types of situations. What other tests do we use to determine IgG levels and what are the levels that indicate partial vs complete FPT?
tests = total solids, sodim sulfite turbidity
partial FPT = IgG 600-800 or total solids 5-5.5 g/dL
complete FPT = IgG <600 or total solids <5 g/dL
100
What causes the clinical signs we see in cases of infection?
the hosts inflammatory response to the presence of the pathogenic organism
101
T/F: Localized inflammation can progress to systemic inflammation, which is responsible for the clinical signs we see at presentation
true
102
What is the most common prepartum route of infection?
transplacental
103
What are the postpartum routes of infection?
umbilicus
respiratory tract
GI tract
wounds
urinary tract
iatrogenic (blood draw, injection, catheter)
104
What are the most common clinical signs of neonatal systemic inflammation / septicemia?
tachycardia
tachypnea
fever or hypothermia
petechia
injected or hyperemic MM
jaundice
joint swelling, lameness
diarrhea
105
What test is strongly indicated in all cases of neonatal septicemia?
blood culture
because bacteremia is present in 50% of septicemia cases, and this will allow us to ID the infectious agent and perform antimicrobial susceptibility test.
106
what are the 4 diagnostic clinical pathology tests that you could run on a neonate with suspected septicemia?
1. Serum IgG
2. CBC
3. Chemistry
4. Arterial/venous blood gas
107
If your neonatal patient is suspected to be septicemic, what would the CBC look like?
leukopenia
neutropenia +/- left shift (immature PMNs)
toxic cell morphology
monocytosis
elevated or decreased fibrinogen concentration (APP, takes 2-3d to increase)
108
You are presented with a sick 1 day old foal who you suspect has septicemia. You run a CBC and Chemistry on this foal and the results show high fibrinogen. When can you infer this infection first began?
Since this foal is only 1 day old and the fibrinogen is increased, you can infer that this infection was present in-utero. Fibrinogen is an APP that takes at least 2-3 days to increase, so given the foals age, the infection began at least 2-3 days prior to the test.
109
You are presented with a sick foal born earlier this morning who you suspect has septicemia. You run a Chemistry on this foal and the results show azotemia. You recheck this value a few times and the azotemia does not resolve. When can you infer this infection first began and what does this tell you about the infection itself?
The infection began in-utero.
At birth its normal to have slightly increase creatinine due to the fact that the placenta is no longer a "kidney" source for the neonate.
However, an increased creatinine could be indicative that the placenta was not working correctly to filter.
110
What chemistry abnormalities are common in a neonate with septicemia?
1. azotemia
2. electrolytes abnormalities (LOW Na, Cl, K, Ca, and Mg)
3. hypolgycemia
4. hypoproteinemia
5. hyperlactatemia
5. elevated hepatic enzyme activities
6. elevated muscle enzyme activities
111
You are presented with a sick 1 day old foal who you suspect has septicemia. You run a CBC and Chemistry on this foal and the results show hyperproteinemia. You are confused because usually neonates with septicemia present hypoproteinemic due to not receiving colostrum... What can account for the hyperproteinemia in this case?
Hyperproteinemia can be relative due to dehydration.
112
What are the pre- and post-suckle blood glucose levels for neonatal foals?
pre = 50-60 mg/dL
post = 75-130 mg/dL
113
T/F: equine neonatal blood glucose levels <180 or >210 mg/dL are associated with poor prognosis for survival
False --
its <50 or > 180 mg/dL
114
A high blood glucose in a neonatal foal is indicative of what...
stress! lots of cortisol and hormones being produced that increase BG
115
_________ is an indicator of impaired perfusion. This value is typically increased at birth (d/t hypoxic period during & post-birth), but steadily declines over the 1st 24 hours. If it is high/does not decline, this is a clear indicator for need for critical care.
Lactate
high lactate indicates that poor perfusion is occuring
116
__________________ is a rapid acute phase protein that increases/decreases within min/hr. High values are strongly suggestive of infection, but normal or low values do NOT rule out infection. Any value less than 100 mg/L in neonatal foals is considered healthy.
Serum Amyloid A
117
What are the 4 goals of treating a septic neonate?
1. prevent further injury/inflammation
2. hemodynamically stabilize patient
3. maintain/support organ function
4. restore homeostasis
118
What is the MOST important treatment option when treating a septic neonate?
Nursing care
clean, dry environment with heat/no drafts
foals -- deep bedding (they get sores easily due to having no muscle mass)
119
T/F: a normal foal with an IgG value between 400-800 mg/dL may not require treatment
true
120
T/F: a foal showing ANY signs of clinical illness, any IgG value less than 800 mg/dL is indication for treatment
true
121
If your patient (12 hour old foal) has FPT-induced sepsis, what is your first line of treatment?
What if the foal was 36 hours old?
colostrum enterally -- it is within the 12-24 hour mark, so you should still administer colostrum IgG.
If the foal is 36 hours old, the intestines are no longer as permeable to IgG, so you should administer antibodies parenterally via plasma (either purchased or taken from the mare)
122
T/F: you should never just assume a neonatal foal is septic, even if they are considered high risk. You must identify the bacterial infection prior to treatment
false -- it is difficult to identify neonates with bacterial infection, so ANY neonatal foal considered high-risk that has clinical illness should be assumed to be septic and should receive antimicrobials.
The risk of NOT treating is greater than the risk associated with treating.
123
What type of antimicrobials are best for neonatal foals with sepsis?
broad spectrum beta-lactams + aminoglycoside
because we cannot tell based on looking at them whether its a gram + or - infection.
(Ex. ceftiofur + amikacin or ampicillin + amikacin)
124
T/F: ceftiofur alone (not in combination with aminoglycoside) has been shown to effectively treat sepsis in neonatal foals
true
125
What is the risk of using aminoglycosides to treat sepsis in neonatal foals with sepsis?
aminoglycosides can cause renal toxicity, especially in septic foals where they are dehydrated, hemoconcentrated, and/or shocky.
However, one or two doses shouldn't be enough to cause any significant issues
126
Your 1 day old neonatal foal patient is septic and you want to administer antimicrobials. You choose oral administration. Is this appropriate - why or why not?
no -- severely ill patients should never be treated orally due to potential ileus and inability to absorb the drugs.
IV administration will reach higher concentrations more rapidly.
127
What is the maintenance rate of fluids for a neonatal foal with sepsis? How should you administer them?
2 mL/kg/hr (~2.5 L per day)
intermittent bolus administration (1 L over 30 minutes)
128
Critically ill neonatal foals (sepsis) are frequently hypoglycemic because they are unable to nurse and have minimal energy reserves.
They may not tolerate CHO supplementation, so what can you do to increase their blood glucose?
isotonic fluids with 50% dextrose
(50-100 mL of it per 1 L fluid)
AVOID rapid bolus --> hyperglycemia
129
Ill neonatal foals that are ambulatory tolerate enteral nutrition pretty well. What is your plan for enteral feeding (route and amount)?
nasogastric tube initially
then try to transition to bucket feeding
goal = 15-18% body weight per day
start with 5-8%, then if tolerating, increase 1-2% q12hr
130
_______ should be given to septic neonatal foals via nasal cannula for respiratory support. The rate is 5-8L/minute.
intranasal oxygen
131
During the first 3 weeks of a puppy's life, what 3 things are they expected to be doing most reliably?
1. eating
2. sleeping
3. actively dreaming
132
At what age do puppy and kitten ears and eyes open?
2 weeks, yet their sight and hearing doesnt actually develop for another week.
133
During the 4th week of a puppy's life, what should be avoided
strong stimuli
134
What age is critical for socialization during puppy development?
weeks 5-7
135
During a puppy's development, they enter a fear period around _____ weeks, where we should avoid strong negative stimuli. This is why some breeders wait until 12 weeks to send their puppies to new homes.
8-10+
136
Describe the rules of 7's in regard to puppy development
in the first 7 weeks...
They should have been on 7 diff surfaces, go to 7 diff places, met and played with 7 diff people, exposed to 7 diff challenges, eaten from 7 diff things/places, etc.
137
at what age do kittens begin to eat solid food and enter a sensitive period for social learning/play?
3-8 weeks
138
If you have orphan puppies or kittens, what it the recommendation for socialization?
get them together with age-matched litter
139
At what age is the mom responsible for assisting the neonate with urination and defecation?
pups - first 3 weeks
kittens - first 2 weeks
140
How much of fetal weight gain occurs in the last trimester of pregnancy in food animals?
2/3rd -- this is why we increase energy and protein levels during this time
141
Hypocalcemia has what effect on the fetus and the pregnancy?
stillbirth
142
What is the term for when the dam does not receive enough energy and thus calves are less able to generate heat to maintain body temp at birth?
protein energy malnutrition
143
Why does obesity increase dystocia risk?
fat is in the way AND because parturition is a process that requires energy and strength to complete
144
Pregnancy toxemia has what effect on the fetus and/or pregnancy?
early/premature feti OR death
145
____________ during pregnancy depresses fetal growth, depresses colostrum quality (antibody content) and quantity, and IgG transfer.
heat stress
146
Which 2 species is there less lee way in induction of parturition and survivability of neonates?
small ruminants -- within 4d
swine -- within 3 days (no sooner than 111d)
cattle -- ok within 14d (much more lee way)
147
If a lamb was just born, what 4 things should you do that are considered "newborn procedures"?
1. resuscitate
2. dip navel
3. clean and milk teats to ensure colostrum present
4. check for swelling of head, tongue, and neck -- if problems, might want to bottle feed colostrum to ensure they get it.
148
Ruminants should have head righting reflex within ____ minutes and will get into sternal recumbency.
5
149
How long after birth would you expect each of these species to stand?
SR --
Calves --
Pigs --
SR -- 10-20 minutes
Calves -- 20-30 minutes
Pigs -- 3-5 minutes
150
How long after birth would you expect each of these species to be nursing?
SR --
Calves --
Pigs --
SR -- 30-45 minutes
Calves -- 45-90 minutes
Pigs -- 3, 25-35 minutes
151
___________________ stimulates maturational events in the lungs, kidneys, liver, and GI tract during induction of parturition.
glucocorticoid hormones
152
At what point should you supplement Calcium to small ruminants versus cattle to reduce the risk of hypocalcemia?
SR -- right BEFORE parturition
cattle -- within first 2 weeks of lactation
153
What are 4 sources of colostrum?
1. dam
2. another dam that has colostrum avail
3. colostrum bank -- frozen
4. colostrum replacer
154
What is the difference between giving a LA neonate colostrum from another dam versus giving it colostrum from colostrum bank (frozen)?
from another dam -- might be subject to CAE, OPP, Johnes, Mycoplasma, Bovine Leukemia Virus
from colostrum bank -- no BLV risk bc frozen, but freezing destroys cellular immunity.
155
how much colostrum should you give to a newborn calf?
7.5% BW within first 2 hours
156
how much colostrum should you give to a newborn lamb/kid?
5% BW within first 2 hours
157
how much colostrum should you give to a newborn piglet?
5% BW within first 2 hours
if the litter is large, remove pigs half way through parturition and put in warm box, then reunite once she is finished birthing them all. this will ensure all piglets get access to colostrum.
158
What is the benefit of bottle feeding vs intubation in LA?
bottle -- allows them to utilize suckle reflex, which will close the esophageal groove and the colostrum will go straight to the abomasum
intubation -- no suckle, colostrum will sit in rumen and then go into abomasum
159
What should the environment look like for a newborn calf?
dry, heavily bedded, and not drafty
160
What should the environment look like for newborn piglets?
temp at 90 F. Heat lamps are useful or plenty straw bedding
161
What is the normal temp for the following species at shortly after birth?
Cattle
SR
Pigs
Cattle: 102-103F, will decrease 1 degree in next hr
SR: 103-104F, will decrease 1 degree by 2d; sensitive to hypothermia
Pigs: 102-103
162
How can you prevent hypothermia in neonates, specifically FA neonates?
dry
tube with warm milk
IV warm fluids -- 5% dextrose and NaCl
place in warm water bath (104, no hotter or blood will shunt away from organs)
heat source of some sort.
163
How often are newborn ruminants fed?
for the first 4 days, they are fed 4x/day (6a, 12p, 5p, 11p)
dairy calves -- 2-3x/day
after 2 weeks: 2x/day
164
how often are newborn piglets fed?
for the first 4 days, every 3 hours
165
How much should newborn food animals eat per day?
15-20% of their body weight
166
Why must you mix milk replacer with WARM water specifically?
the heat emulsifies the fat
167
You should feed (higher/lower) fat milk replacers when it is cold
higher
168
What ingredients are critical in milk replacer for food animals?
whey, dried protein powder
provides energy
169
What is the #1 cause of death within the first week of life in pigs?
crushing!!
this is why farrowing crates are helpful
170
What parameters are vital to check in neonates to avoid problems?
1. eating -- is there any milk coming from their nose?
2. breathing -- pneumonia, lack of insufflation
3. urinating -- any dribbling at umbilicus =patent urachus
4. enlarged umbilicus -- omphalitis, umbilical hernia
5. defecating -- meconium impaction, atresia ani, atresia recti, atresia coli
171
T/F: 2 days after birth of any calf, lamb, kid, or piglet you should be able to see signs of atresia coli or recti if present
false
pigs can go a whole month before showing problems, however they will be bloated.
172
What is the #1 cause of meningitis in neonatal FA?
FPT
173
What causes meningitis in neonatal kids?
mycoplasma and hyperthermia
174
what causes menigitis in neonatal kids and lambs?
polio
175
what causes meningitis in neonatal piglets?
streptococcus suis
176
what causes anemia in neonatal pigs?
iron deficiency
177
How can you prevent anemia in neonatal pigs with iron deficiency?
give iron injections at 2 days
178
What are the most important diagnostic tests for sick neonatal foals?
1. IgG
2. CBC/Chem (with blood glucose)
3. Blood culture
4. Lactate
5. U/S or radiograph
6. +/- nasogastric intubation
7. fecal culture (if infectious cause is high on list)
179
How can you diagnose meconium impaction in neonatal foals?
1. radiograph
2. ultrasound
3. PE and Hx -- adbominal distention, firm manure in rectum on palpation, colic signs, straining to defecate
180
what is the treatment for meconium impaction in neonatal foals?
1. laxatives -- mineral oil
2. enema -- acetylcysteine is safest and most effective
3. Flunixin meglumine
4. Fluid therapy (LRS) to encourage gut motility
5. withold nursing (d/t ileus)
181
If a neonatal foal presents to you with diarrhea, what main things are on your differential list?
1. non-infectiou: foal heat
2. infectious: rotavirus, coronavirus, C. diff or perfringens, salmonella, R. equi, L. intracellularis
3. Parasitic: strongyloides westeri, cryptosporidium parvum
182
What diagnostic tests are best for neonatal foals with diarrhea?
1. stall-side lactate, glucose, PCV, and TS
2. CBC/Chem
3. abdominal U/S
4. IgG
5. Blood culture
6. Fecal culture, PCR panel, and acid fast stain
183
How do you treat equine rotavirus in a neonatal foal?
1. IV fluids (LRS with electrolytes)
2. nutritional support
3. lactase supplementation
184
what is the most common form of placentitis in mares caused by?
failure of barriers (vulva, vagina, cervix)
185
What organisms are most commonly involved in ascending placentitis of mares?
strep zoo*
e. coli
P. aeruginosa
other fecal bacterias
aspergillus and other fungal
186
If a mare presents to you with premature indicators of pregnancy such as udder development/edema, milk production, perineal relaxation, and vulvar relaxation, what is your first differential?
ascending placentitis
187
If a mare presents to you because she has had an abortion due to diffuse systemic placentitis, what is your differential?
Hint: this cause has a vaccine available
leptospirosis systemic placentitis
188
An owner calls you because 2 of her mares have had abortions in the past 6 months. She sends you a picture of the placentas and they both had different coloration at the body and base of the horns. What is the most likely diagnosis?
nocardiform (gram + bacteria) systemic placentitis
189
An owner calls you because 9 out of 11 of her mares have had an abortion within this breeding season. There was no trend to early vs late term. She said nothing has changed on her farm except that shes been finding a lot of caterpillars in the pasture. What is your presumptive diagnosis based on this info?
mare reproductive loss syndrome due to the eastern tent caterpillars.
190
You have an equine patient that you suspect could have ascending placentitis due to her having premature signs of impending parturition. You do a physical exam, rectal palpation and abdominal ultrasound. What would rectal palpation and U/S findings be for her?
palp: increased placental thickness (CTPU) at the back of the uterus near the cervical star
U/S: fetal HR, clear or cloudy fetal fluids (cloudy is poor prog indicator), CTUP.
191
How do you differentiate ascending vs systemic placentitis in mares just by looking at the placenta?
ascending -- infection is located near cervical star
systemic -- infection is located at base of horns and body
192
What is the treatment for placentitis in mares?
If she had an abortion -- no tx for mare because it'll clear on its own.
if the fetus is non-viable -- induce abortion and refer because of potential dystocia
if fetus is viable, systemic antibiotics (TMS or based on c/s), NSAIDs (flunixin), progesterone (to maintain pregnancy), and estradiol cypionate
193
what is the prognosis for placentitis for the foal versus the mare?
guarded/poor for foal if...
- there is premature placental separation (bc of neonatal hypoxic ischemic encephlopathy)
- septicemia from hematogenous spread
fair to good for mare
194
What effect does endophyte-infected fescue have on pregnant mares?
prolongs gestation --> larger foals with poor muscling
abortion from dystocia
thickened placenta +/- premature separating
retained placenta
agalactia
195
Fescue toxicity in pregnant mares is preventable by removing her from the source at least 60-90 days before foaling. If this does not occur, what could you do to treat the mare after being infected?
Domperidone -- a dopamine antagonist that increases prolactin production
give 10-15d prior to parturition or 5-10d post foaling
196
what is the prognosis for fescue toxicity in pregnant mares?
guarded without treatment but good with treatment
197
what are the clinical signs of uterine torsion in a pregnant mare?
low-grade persistent colic
dystocia
abortion (5-11 months)
198
how do you diagnose uterine torsion in a pregnant mare?
palpation per rectum
199
what is the biggest concern with uterine torsion in pregnant mares?
compromise to the uterine blood flow leading to
uterine rupture or detrimental to the fetus
200
what is the treatment for uterine torsion in pregnant mares?
rolling
surgery -- either standing flank or midline
always monitor fetal viability
201
A mare presents to you immediately post-partum because she had signs of colic and now has pale MM and tachycardia. You palpate her and upon palpating her broad ligament, you feel a mass along one side of the body of the uterus. What is the cause of this/what is your presumptive diagnosis?
uterine artery rupture and hematoma.
202
what is the treatment for a mare with uterine artery rupture?
1. fluids
2. meds to stop the bleeding
3. blood transfusion if needed
203
A pregnant mare presents to you very painful. On examination, you notice that her ventral abdomen is hanging lower than it should in a normal horse. She also has some udder edema and congestion. You already know the prognosis is poor. What is your presumptive diagnosis?
preputial tendon rupture
204
what causes preputial tendon rupture in mares?
when they are pregnant that is extra weight on this tendon, so if they have twins this could be too much weight.
hydroallantois, being aged, and being a bucking mare during pregnancy can lead to rupture as well.
205
A pregnant mare presents to you because the owners report that her belly seems wider than normal suddenly. You palpate her and perform ultrasound. Based on this you diagnose her with hydroallantois. Describe how you knew it was this condition by palpation and ultrasound?
on palpation, you'll feel a large fluid-filled uterus
on u/s, you'll see excess fluid accumulation (which is d/t placental dysfunction)
206
What is the treatment for hydroallantois in horses?
induce parturition and refer because she will need to be on fluids to correct the amount of fluid/electrolyte loss she is about to experience.
207
An owner calls you because her pregnant mare has something red sticking out of her vulva. She sends you a photo and you confirm the red, velvety placenta with the cervical star. What is it and what advice do you give her?
This is called premature placental separation aka red bag. This occurs when the chorion separates from the endometrium. Placentitis and fescue are causes for this.
You advise her to rupture it quickly and deliver the fetus carefully because the fetus will get hypoxia. You also tell her that this foal is going to need close monitoring post-partum to watch for hypoxic ischemic encephalopathy.
208
A mare presents to you because she is bleeding from her vulva a few days after giving birth to her foal. You palpate her and determine the cause is likely foaling trauma (bruising, swelling, or even tearing). If you determine the trauma is in the uterus, what is the treatment?
its an emergency if its full thickness -- d/t peritonitis risk.
surgery and supportive care (oxytocin for involution)
209
A mare presents to you because she is bleeding from her vulva a few days after giving birth to her foal. You palpate her and determine the cause is likely foaling trauma (bruising, swelling, or even tearing). If you determine the trauma is in the cervix, what is the treatment?
none OR delayed surgery if >50% of the length is affected.
210
A mare presents to you because she is bleeding from her vulva a few days after giving birth to her foal. You palpate her and determine the cause is likely foaling trauma (bruising, swelling, or even tearing). If you determine the trauma is in the vagina, what is the treatment?
none OR delayed surgery (6 weeks)
211
A mare presents to you because she is bleeding from her vulva a few days after giving birth to her foal. You palpate her and determine the cause is likely foaling trauma (bruising, swelling, or even tearing). If you determine the trauma is in the vulva, what is the treatment?
none OR closure to repair the seal
212
Retained placenta (retained >3hrs post foaling) is common in mares. What 4 things put a mare at higher risk for retention of placenta?
1. dystocia
2. abortion
3. severe placentitis
4. foal doesnt nurse
213
which placenta portion is most likely to be retained in mares?
the non-gravid horn because its thinner and easier to tear.
214
what is the sequelae to a retained placenta in mares?
none if treated quickly
delayed uterine involution
metritis
septicemia/toxemia
laminitis
death
215
How do you treat retained placenta in mares?
if early (3-5 hr post foaling): give oxytocin, NSAIDs, +/- uterine lavage with dilute betadine, or use placenta weights
if later (hrs to days post foaling): systemic antibiotics (broad spec), systemic NSAIDs, ecbolics (oxytocin, PGF), uterine lavage, burns procedure (fill placenta with fluid, tie and keep in uterus to help her contract.
*DO NOT MANUALLY REMOVE THE PLACENTA, YOU WIL SCAR THE UTERUS.*
Inform owner that it may recur and it may decrease pregnancy rates
216
why are pregnant mares at risk for colic?
they are experiencing dietary changes (more grain) and housing changes (stall). most importantly, they experience a sudden change in their abdominal fill when they give birth (large colon volvulus, uterine torsion, etc.)
217
how can you prevent colic in pregnant horses?
move to stall prior to foaling
return to normal housing after
slow changes to feed
encourage lots of water intake
