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Neonatal immaturity : How to act properly

Dott. Giovanni Majolino DVM  - Collecchio (Pr) Italy
Specialised in Small Animal Diseases
Past-President of Society for  Reproduction of Pets (Sirvac)
Dott.ssa Raffaella Ranieri DVM – Collecchio (Pr) Italy
Specialised in Small Animal Diseases.

Neonatal death is a possible event that really scares breeders, with an incidence from 10 to 30% for the period in-between birth and the first 7 days of life (12% deaths on average) with a death rate of 65% during the first 15 days.
Neonatal pathologies are among the biggest worries of breeders as for the related frustration  and  economic loss they cause.
Newborns’ health is conditioned by different factors, in particular: by parents conditions, as for their genetic pool, by mother and its kind of feeding during pregnancy and breastfeeding, and by the hygiene of the delivery room.
Following a list of the main 4 health care approaches to adopt with premature newborns: oxygenation, heating, re-hydrating and feeding.
OXYGENATION: The first breathing of the newborn is extremely important, especially when it is premature or when at expulsion it is pedal. Under these conditions the first breath may occur before pup’s complete expulsion, with the risk of inhaling liquids at pulmonary level.
This may be also possible when it takes place a premature detachment of placenta, potentially derived from a bad use of oxytocin.
Evidence has shown that sometimes young bitches, often troubled at delivery, do not take enough care of their newly-born puppies. In case the amniotic sac is not broken as soon as possible just after the expulsion (by the first 2 minutes at least) the pup might die from aspiration of the liquid contained into it (amniotic liquid). In order to tackle this event, one should take the pup, while keeping its head down-turned and its mouth open, and carry on soft but oscillating movements aiming at encouraging the expulsion of the eventually inhaled liquids.
In order to clear nostrils it is also possible to use an enema bulb.
Whenever the above mentioned operation does not give any result, a respiratory analeptic (doxapram) may be also used: it is sufficient to put 1 or 2 drops of it under the tongue after having controlled the airways.
Whenever the mother remains inactive after placenta expulsion, it is necessary to sever the umbilical cord with an absorbable wire at about 1-2 cm from puppy’s abdomen, to then cut the cord at 1 cm from the severance. In absence of suture wire, it is also possible to tweeze the cord with a sterile tweeze for 1-2 minutes till haemostasis, to finally cut it at about 2 cm from pup’s abdomen. After this operation it is important to disinfect the stump of the umbilical cord with a gauze soaked in a disinfectant like clorexidine, aiming at avoiding eventual homphalitis.
HEATING : when a bitch is troubled or does not show any maternal instinct thus  avoiding leaking its puppies, it becomes necessary to massage pups with a clean cloth, especially on thorax, to stimulate their breathing.
Since the thermoregulation of newly-born puppies is not yet active, they are really sensitive to coldness. 
Moreover neonatal hypothermia may be worsened by the lack of shivering reflex (absent till the sixth day of life) and by a fine fatty tissue.
Even though pups tend to keep themselves warmed through a close body contact, they are completely dependent on environmental temperature for at least their first 15 days of life. Pup’s body temperature stands usually between 35,5-36,5 °C at the first week, reaching 38 °C at the 3rd week.
When the temperature decreases to 35 ° C, a puppy becomes unable to self-feeding and, even if crying, it is often dismissed by its mother; at a body temperature of 22 °C it is amorphous.
Usually it is not difficult to avoid pups’ hypothermia by keeping the delivery room and the delivery box at a constant temperature.
The temperature of the delivery box should be at 31 °C at puppies birth to then gradually reach  22°C at the third week.
In presence of an hypothermal puppy it is essential to provide an increasing heating for the following 1-3 hours, using hot water bags, warm cloths or heating platforms installed into the delivery box.

It is necessary not to heat puppies too quickly, in order to avoid peripheral  vasodilatation which would increase oxygen blood needs, thus provoking an excessive cardio-pulmonary effort which may be even mortal.
Another essential recommendation is keeping delivery room moisture between 55-60 %.

REHYDRATING A pup is not only sensitive to low temperature, but also dehydration may cause as well a series of problems such as weight loss.
There are many reasons  why puppies tend so often to be dehydrated : firstly 82% of newborn weight consists of water, the body surface is very important: skin represents 25% of total weight, the entericcoated layer at birth is almost absent and it will be definitely active only after 20 – 30 days
Pup’s kidneys are completely premature, the reabsorbtion of the water filtered by them is no more then 20-50 % compared to the normal amount of an adult dog.
Delivery room moisture should ideally be about 55-60 %, if it reaches 35 % the risks of pulmonary water loss are considerable.
On the other hand a moisture degree of about 80-90 % is not recommended, apart from the very first phase of dehydration. Higher values would enhance bacterial proliferation.
In order to heat ill puppies it is preferable to use hot water bags or the moderate temperature produced by the heating platforms, rather then infrared lamps as they tend to make the environment too dry.
Pups’ daily water intake is about 1-2 ml/100 gr. weight.
A dehydrated puppy cannot feed itself, it loses vitality, gets cool and it is finally dismissed by its mother. 
Weight loss usually can give more indications about pup’s dehydration than the permanence of coetaneous plicae.
If the pup during its first 24 hours, loses more than 10% of its weight at birth, it must be immediately re-hydrated with a feeding bottle of sugared water and, if it does not recover, it will be necessary to administer a subcutaneous physiological isotonic solution (1 ml/30 gr  weight). 
NUTRITION an adult dog can easily use fats as source of energy, going without food even for 3 weeks without any symptoms of hypoglycaemia.
By contrast a newly-born puppy, till the first 5 days or more, if premature,  is not provided with any fat stock and its enzymatic potential essential for neoglucogenesis is insufficient. After birth a puppy needs to keep constant standard values of glycaemia through a frequent breastfeeding provided by its mother or by a nurse bitch or alternatively with bottle feeding.
Bitch milk represents the best feed for newborns, provided that it is of good quantity and quality. Whenever a bitch is affected by mastitis or it has an insufficient lactation it becomes necessary to give all the pups breast milk substitutes.
Given that a newborn shouldn’t lose more than 10% weight in its first 24 hours, it will be essential to use breast milk substitutes when the puppy does not show any weight increase on its second day of life.
It is commonly deemed that daily weight increase of puppy should be of about 2 gr /each Kg of adult weight ( for instance a labrador whose adult weight will be about 35 kg, should grow of about 70 grams a day).
When the bitch is absent or does not take care of its pups, it is important to stimulate urination and defecation with a massage in the perinea area with a wet cotton wadding.
An easy technique to adopt when the newborn is not able to self-feeding, is gastric intubation.
Before intubation it is advisable to check the intubator length, considering the distance between mouth and sternum, in order to avoid gastric perforation, the syringe is full and the eventual inside air is expelled.
The puppy must be kept in horizontal position with its head along its body so that the inserter can easily slide into the oesophagus .
The intubation must be delicate without forcing the injection, milk progressively and slowly injected into the stomach must be at a temperature of 37-38 °C; a little resistance indicates that the stomach is full.
More precisely the stomach volume of a pup represents about 5 % of its own body weight (a 500 gm. puppy can eat 25 ml of milk). It is recommended to repeat this operation 4 times a day at least.* (dietary scheme)
A careful and conscientious breeder should be aware of these few remarks, so that, along with the help of a veterinary, puppy’s death can sharply decrease, as it represents an event causing distress and discouragement to those who raise with passion and dedition.

NEONATAL THERAPIES: healthy puppies must show a daily increase of 2-4 gm per kg of adult weight, during their first 5 months of life.. For example a pup, whose adult weight will be of about 10 kg, should grow from 20 to 40 grams a day.
Another parameter to be considered might be  10% increase of weight at birth.
BOTTLE FEEDING: Breast milk substitutes for pups provide on average from 1 to 1,24 kcal of metabolisable energy each ml of reconstituted milk .
The daily amount of milk is about:
13 ml reconstituted milk each 100 gm of weight at the  1° week
17 ml    “           “           “       “     “         “         “         2°        “
20 ml    “           “           “       “     “         “         “         3°        “
22 ml    “           “           “       “     “         “         “         4°        “
these amounts must be  equally distributed into 5-6 day meals.
Reconstituted milk temperature must be  37-38 °C

PHARMACOLOGICAL ASSISTANCE AT DELIVERY: it will be veterinary responsibility the choice of being supported by drugs, in order to achieve delivery.
There is only a short list of medicines to be used with the awareness that the lack of expulsion is not caused by a dystocia with the obstruction of the delivery canal.
OXYTOCIN: it is effective with a subcutaneous or intramuscular dosage between 1-10 UI, these substance enhance uterine contractions without making them more powerful. In case of “listless” delivery, higher dosage may cause excessive miometrious spastic contractions with the risk of a premature placental detachment and consequent hypoxia in the puppy.
10% GLUCONATE CALCIUM: it increases contractions intensity with a minor risk of spastic miometrious contractions. It is effective at 1-4 ml subcutaneous dosage according to patient’s sizes. An interval of 20-30 minutes, for a maximum of 3 administration, is also recommended. 

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