Neonatology Flashcards
(86 cards)
1
Q
beef calf mortality
A
Birth to Weaning – 6-8% average
57% in first 24 hours
75% in first 7 days
2
Q
causes of beef calf mortality
A
Dystocia – 17.5% Stillbirth – 12.5 % Hypothermia – 12.2% Diarrhea – 11.5% Respiratory – 7.6%
3
Q
factors affecting the neonate
A
- Proper fetal development
- Successful parturition
- Adaptation to Extrauterine life
- Nutritional support
- Colostrum and passive transfer
- Infectious disease
4
Q
oranogenesis
A
12-42 days
5
Q
organ development
A
50-150 days
6
Q
organ growth and maturation
A
last trimester
70% of birth weight
7
Q
fetal membranes and fluids
A
- Transfer oxygen and nutrients
- Elimination of fetal wastes
- Fetal protection
8
Q
parturition
A
Severe stress w/ some oxygen deprivation
Adaptive mechanisms
Catecholamine surge
High serum cortisol
Point : Effects of catechalamines and cortisol can
mask conditions in neonate immediately
postpartum
Crashes – can and do occur a few hours later
9
Q
extrauterine adaptation
A
Most fetal organs well developed by late gestation
Duration of transition varies for each organ system
Respiratory – immediate
Immune – weeks to months
Each neonate adapts at own rate depending on
vigor, strength, stress of parturition, maternal
support, environment
Fetal-> Neonatal blood circulation
Initiate pulmonary function
Regulate acid-base balance
Engage metabolic pathways for energy metabolism
Thermoregulation
Absorb maternal immunoglobulins
passive transfer of immunity
10
Q
fetal circulation
A
Placenta Umbilical vein Ductus venosus Ductus arteriosus Foramen ovale Pulmonary circulation High pressure, low flow system 10% cardiac output Umbilical arteries
11
Q
cardiopulmonary changes at birth
A
Umbilical separation Aeration of lungs Low pressure, high flow Surfactant Laryngeal sphincter Closure of: Ductus venosus Ductus arteriosus Foramen ovale Pulmonary fluids Heart rate: 100-140/min (120) Respiratory Rate: 30-60/min(48)
12
Q
initiation of spontaneous respiration
A
Loss if immersion reflex which inhibited breathing
in-utero
Respiratory centers of the medulla are stimulated
by cold, light, tactile sensations and flexion of limbs
Arterial pO2 and PH decrease, pCO2 rises and the
peripheral and central chemoreceptors are
maximally stimulated
13
Q
pulmonary events associated with birth
A
Thoracic cavity compression in normal anterior
presentation
Partial expulsion of fluids from lungs
Elastic recoil of thoracic cavity after passage
through vagina causes aspiration of air into lungs
and upper airways
Diaphragmatic rhythmic contractions causing a
increasing negative intrathoracic pressure aiding in
further inflation of lungs
Absorption of lung fluids
14
Q
causes of respiratory distress and acidosis
A
Partial or premature placental separation Prolonged uterine contractions Umbilical cord compression Maternal hyperventilation Cesarean section/malpresentation Pharmacologic agents Immaturity
15
Q
stimulating respiration
A
Clear fetal membranes Clear airway fluids Suction vs. gravity Stimulate breathing Massage Nasal stimulation Artificial respiration
16
Q
acid-base balance and energy metabolism
A
Transient mild metabolic acidosis and respiratory
acidosis following rupture of the umbilical cord.
Acid-base balance is usually normal prior to separation
After separation the acid-base changes are due to
anaerobic metabolism and establishing respiratory
function
Metabolic acidosis usually corrected by 1-4 hours post
birth
Respiratory acidosis often persists for 48 hours or longer
17
Q
energy metabolism
A
Energy sources: Hepatic and other glycogen stores Utilized within 4-6 hours Brown adipose tissue Utilized within 1-5 days Nutrition of dam Colostrum and milk Required for survival
18
Q
thermoregulation
A
Environment Moisture Wind Temperature Maternal Behavior Energy Activity
19
Q
hypothermia
A
Body Temp <98 F Suckle reflex Shivering? Energy – warm colostrum/milk Warm Calf/lamb Hot water bath vs. warm air Dry Warm oral fluids Calf/lamb coats Heat lamps Do not warm before administering an energy source (i.p. dextrose or warm colostrum.) Causes seizures
20
Q
findings in neonates born in severe dystocia
A
Meconium staining
Severe metabolic acidosis/respiratory acidosis
Elevated circulating lactate levels
Organ system dysfunction/Neonatal asphyxia
Difficulty maintaining body temperature
Erratic blood glucose maintenance
Central nervous system damage
Neonates surviving these events may show an
increased risk of disease later in life.
21
Q
successful parturition
A
Health of Dam Size of fetus Presentation and posture Anterior presentation Posterior presentation Assistance
22
Q
stage one of parturition
A
Myometrial contractions
Positioning of fetus
Restlessness of mare
23
Q
stage two of parturition
A
Rupture of chorioallantois
Delivery of fetus within 20 min.
24
Q
stage 3 of parturition
A
- Myometrial contractions continue
* Explusion of placenta
25
PE of neonatal foal
```
Length of gestation
315-365 days
Time to stand
1 hour
Time to suckle
2 hours
Passage of the placenta
3 hours
```
26
post partum care- foals
Umbilicus
Allow to break naturally – 5 cm from body wall
Manually break if necessary
Never cut
Dip umbilicus- 0.5% chlorhexidine solution
Suckling behavior
Clean bedding
Wash udder and perineal area
20 ml/kg (2-4 liters)of good quality colostrum (sp.
Grav.>1.060)
27
FPT
```
Premature lactation – twin
pregnancies, placentitis, premature
placental separation
Failure to ingest colostrum
Low IgG content of colostrum or failure
to produce colostrum – Fescue toxicosis
Poor absorption of IgG – Ill and
premature foals
```
28
neonatal maladjustment syndrome
* Gross behavioral abnormalities
* Multiple organ system dysfunction
* Hypoxic-ischemic damage to the CNS
* Dummy foal, barker, wanderer
```
Clinical presentation
Clinically normal from birth – 36 hrs
Sudden loss of suckle reflex
Weakness, disorientation, aimless wandering
Simi-comatose or seizing
Clinical course/Prognosis
Improvement by 48-72 hrs
Signs persisting for > 4 days – guarded prognosis
```
29
patent urachus
```
Hospitalized debilitated neonates
Simultaneous infection of the
umbilicus (Navel Ill)
Foals straining to defecate
Treatment:
Cauterize
Surgical excision
```
30
neonatal isoerythrolysis (NI)
Mare produces antibodies against foal’s RBC’s
Antibodies ingested via colostrum
Etiology
Foal inherits blood group antigens from sire
History of blood transfusion
Aa/Qa negative mares most commonly affected
Antibodies not made during first pregnancy
31
NI clinical signs/diagnosis
```
Foals born healthy
Signs develop at 24-36 hrs
Lethargy, weakness, pale membranes
Severe jaundice (icterus)
Diagnosis:
Cross match
Hemoglobinemia and hemoglobinuria ( intravascular
hemolysis)
Coomb’s test
```
32
NI treatment
```
Minimize stress, restrict exercise
Intravenous fluids, diuresis
Broad spectrum antibiotics
Whole blood transfusion for severe anemia
(PCV 10-15%)
Restrict nursing
```
33
NI prognosis
* Depends on quantity of antibody ingested
* Rapidity of onset of signs
* Degree of anemia
* Prevention
* Screening for anti-RBC antibodies
34
ruptured bladder (uroperitoneum)
```
History
Commonly occurs during parturition
+/- history of dystocia
Male foals>female foals
Typically normal at birth
+/- straining to urinate
```
35
surgical treatment
```
Post-operative care
Broad spectrum antibiotics
Urinary catheter
Prognosis
Good
Complicated by concurrent septic
```
36
foal diarrhea
Causes
Bacteria – Clostridium sp. Salmonella, R equi
Foal heat
Viruses – Rotavirus
Paraites – Strongyloides westeri, S. vulgaris,
Cryptosporidium
Nutritional – lactase deficiency
37
foal diarrhea therapy
```
Fluid therapy – sodium containing fluids
Dextrose/potassium supplementation
Systemic antibiotics
Parenteral nutrition
Intestinal protectants – peptobismol
Anti-ulcer medications – preventative
Plasma/hetastarch – protein loss
Desitin ointment
```
38
colic
* Meconium impaction
* Atresia (anus, colon)
* SI intussusception
* SI volvulus
* Ascarid impaction
39
colic treatment
```
Warm soapy water enema
Acetylecysteine retention enema
Analgesics – banamine, ketoprofen
Mineral oil
Fluid therapy
trocarization
```
40
gastroduodenal ulcers
```
Gastric ulcers
Bruxism, decreased appetite
Occur in squamous non-glandular
portion of the stomach
Pyloric/duodenal ulcers
Impaired gastric emptying
Excess salivation, bruxism, dorsal recombancy.
```
41
causes for ulcers
Multifactorial – stress, concurrent disease,
| nonsteroidal anti-inflammatory therapy
42
diagnosis of ulcers
Clinical signs
Endoscopy
Abdominal radiography with contrast
43
ulcer treatment
Decrease acid secretion – Ranitidine,
cimetidene, omeprazole
Gastric protectants – Sucralfate
Promote gastric emptying - Metaclopramide
44
botulism (shaker foal synfrome)
Clostridium botulinum
Clinical signs
Progressive muscular weakness
Toxin blocks acteylcholine release at the
presynaptic junction – neuromuscular weakness
Route of infection
Ingestion of organism which elaborates toxin
45
clinical presentation of botulism
```
>4 weeks of age
Progressive weakness to recombancy
Bright and alert
Milk dribbling from mouth/nostrils
Poor tongue, tail, and anal tone
Dilated pupils
Death due to respiratory paralysis
```
46
treatment of botulism
```
Antitoxin (specific for type involved)
Penicillin IV
Avoid IM penicillin, tetracycline's,
aminoglycosides
Indwelling nasogastric tube
Ventilator support
```
47
prevention of botulism
vaccination with type B toxoid
| Environmental?
48
fetal immune system
```
Development
50 to 180 days of gestation
Self recognition
Maturation
Functional at birth
Naïve
Less responsive
```
49
passive immunity
```
Colostrum
Last 4-6 weeks of gestation
Maternal Antibodies (IgG)
Energy rich
Requirements
Adequate Production
Adequate Intake
Adequate Absorption
```
50
antibody/immunoglobulin five classes
```
IgG
IgM
IgA
IgE
IgD
```
51
IgG
most abundant, most prevalent in serum and
| colostrum
52
IgM
most efficient in neutralization of viruses and
| toxins.
53
IgA
secreted on mucosal surfaces of respiratory,
intestinal and genital tracts and is the primary
humoral defense in these tracts of the new born
54
IgE
allergic reactions
55
IgD
mice and humans
56
adequate colostrum production
* Beef vs. Dairy
* Heifers vs. Cows
* Vaccination
* Nutrition
* Full Gestation Length
* Storage
57
FPT
failure of passive transfer
58
adequate colostrum intake
* Beef colostrum: 1-2 quarts
* Dairy colostrum: 4 quarts
* Maternal behavior
* Calf strength
* Dummy calves
* Nursing vs. tubing
59
adequate colostrum absorption
```
Open gut
First 6 to 12 hours
Decreased absorption
Hypoxia
Compromised circulation
Hypothermia
Competing proteins
Too late
```
60
monitoring passive immunity
```
Colostrum Quality
Calf Serum IgG
Total Protein (>5.5 mg/ml)
Precipitation tests
Association with Disease
Ig G status
Exposure
```
61
total protein disease risk
* TP>5.5 mg/ml = adequate
* TP<5.0 mg/ml = Failure
* Mortality Risk:
* TP 6.0-6.5 = MR of 1
* TP 5.5-6.0 = MR of 1.4
* TP 5.0-5.5 = MR of 2.1
* TP 4.5-5.0 = MR of3.3
* TP < 4.5 = MR of 6.0
62
colostrum supplements
* Calf needs at least 100 grams IgG
* Colostral Supplements < 10 grams
* Compete with maternal IgG
* Inadequate
* Plasma
63
colostrum storage
```
Frozen Colostrum
6-12 months
Beef vs. Dairy
Concentration
Contamination
Thawing
Warm water – 110 F
Microwave – 60% power, in a time pinch, and
known good quality colostrum. Microwaves
will destroy immunoglobulins.
```
64
neonatal infectious disease
* Neonatal Septicemia
* Calf Scours
* Pneumonia
65
physiological parameters
* Temperature: 100-103 F
* Heart rate : 100-140/min (120)
* Respiratory rate : 30-60/min (48)
66
neonatal septicemia
Bacterial infection in the blood
67
entry of septicemia
Respiratory tract
Intestinal tract
umbilicus
68
prevention of septicemia
Colostrum
Vigorous Calves
Environment
Dip naval
69
symptoms of septicemia
```
Clinical signs
Weakness
Decreased nursing
Scleral injection
Mucous membranes
Increase HR and RR
+/- Diarrhea
Fever is rare (subnormal temp)
```
70
treatment of septicemia
* Antibiotics
* Anti-inflammatory drugs
* Fluids
* Plasma or blood transfusion
* Nursing care
71
calf/lamb scours
```
Bacterial
E coli
salmonella
Viral
Coronavirus
Rotavirus
Protozoal
Cryptosporidium
Coccidia
```
72
factors in scours
* Environmental exposure
* Inadequate colostrum
* Dystocia
* Poor nutrition of the dam
* Health of dam
* Mothering ability
73
pathogenesis
```
Secretory diarrhea
E. coli
Malabsorptive diarrhea
Coronavirus and Rotavirus
Cryptosporidia
Osmotic diarrhea
Excessive milk
Maldigestion
```
74
e coli
```
Enterotoxigenic
Secretory
Other types
Invasive
Hemorrhagic
Pathogenic
Stable in environment
Susceptible to disinfectants
```
75
rotavirus and coronavirus
```
Infect intestinal epithelium
Destroy epithelial cells
Digestive function
Secretory function
Absorptive function
Moderately stable in environment
Susceptible to disinfectants
```
76
salmonella
* Colonize intestine
* Destroy intestinal epithelium
* Invade into tissues
* Septicemia
* Stable in environment
* Susceptible to disinfectants
77
cryptosporidium
```
Invade into intestinal epithelium
Shed in high numbers
Immediately infective
Stable in environment
Resistant to disinfectants
Reservoir and sources
Rodents and wildlife
Infected calves to 4-6 months
Not adult cows
```
78
calf scours- signs
```
Diarrhea – white, yellow, red(blood)
Dehydration
Weakness
Decreased nursing
Increased HR and RR
Scleral injection
Mucous membranes
```
79
scours treatment
```
Maintain hydration status
Oral fluids
Sub Q fluids
IV fluids
How much fluids
% dehydration x body weight (kg)
Kilograms -> liters or quarts
```
80
determining hydration status
1.Take the % dehydrated and multiply by the calf’s body
weight in kg.
2.For example, an 80 lb. (36 kg) calf is determined to be 9%
dehydrated.
.09 X 36 kg = 3.24 – This means that 3.24 liters of fluid (oral
electrolytes, SQ, or IV fluid) are required to replace what has
been lost.
3.After the initial calculated fluid dose is administered,
additional fluids can be given at a rate of 5 mL for every 2.2 lbs., every hour. In addition to the 5 mL/2.2 lbs/hour, an additional 1-4 liters each day may be required to keep up with continued fluid losses because of diarrhea, etc.
1 gallon = 3.7 liters and 1 kg =2.2lbs
81
oral fluid treatment
```
Can calf suckle?
Is calf <5% dehydrated?
Fluid choice
Commercial vs. home made
Alkalinizing vs. Non-alkalinizing
How much? How often? How long?
Two feedings -> feeding q 2 hours
Continue milk feeding? 30 min. apart. Do not
mix fluids with milk replacer.
```
82
subcutaneous (SQ) fluid administration
```
Calves 6-8% dehydrated
Warm fluids to body temp
Sterile isotonic fluid (0.9% saline)
No glucose in fluid
Administer skin areas of neck,
shoulder, and behind elbow.
500ml in one location, 2 liters total
4-6 hours to absorb
```
83
intravenous (IV) fluid administration
```
When dehydration > 8%
Sterile catheter
Bicarbonate/glucose may be needed
Two thirds of calculated amount given in
first hour. Give rest over 2-3 hour period
Additional 5 ml per 2.2lbs per hour
Additional 1-4 liters/day may be needed
due to fluid losses from diarrhea, etc.
```
84
scours treamtent
```
Antibiotics
Some calves are also septic
Look for signs of sepsis
Choice of antibiotic
Duration of treatment
Anti-inflammatory drug?
Severity
Ulcers
```
85
vaccinations
```
When?
What?
E. coli
Rotavirus and Coronavirus
Clostridium perfringens types C and D
4-way respiratory
MLV vs. killed vaccines
Calf vaccines
```
86
managing calf scours
```
Calve heifers in a separate location
Quarantine all calves with diarrhea and their dams
Nutrition of dams in late gestation
Protein
copper
Manage the environment
```
