Effect of delivery management on first-week neonatal outcome: How to improve it in Great Danes

Neonatal-Maternal Bodyweight Ratio at Birth: An Indicator for First-Week Survival Prognosis in Canine Newborns

Objectives. In dogs, neonatal bodyweight (NBW) varies at birth. Size-specific reference values for NBW are essential to correctly manage newborns. The present study aimed to define a new tool to evaluate NBW that could be routinely applied in canine neonatology, promptly identifying puppies requiring more care. Methods. The records of 89 litters were retrospectively evaluated. Data were grouped according to maternal bodyweight (MBW) in five categories: toy (≤5 kg), small (5.1-9.9 kg), medium (10-24.9 kg), large (25-39.9 kg), and giant (≥40 kg) dogs. At birth, the NBW of 412 puppies, alongside their litter size (LS) and gender (G), were recorded. Neonatal mortality within the first week was considered. The influence of MBW, LS, and G on NBW and the effect of NBW on the 1-week outcome were evaluated using ANOVA (p < 0.05). The ratio between NBW and MBW expressed as a percentage (N-MBW%), was assessed for each puppy. Through Receiver-Operating Characteristic (ROC) curves, N-MBW% thresholds between puppies alive or dead at one week of age were calculated in each group. Results. The LS was different among groups, except for small vs. medium dogs. In small litters, N-MBW% was lower in medium-, large- and giant-sized dogs than in toy and small dogs. In medium and large litters, N-MBW% differed among the five groups. Male and female N-MBW% differed among the five groups. Only in large and giant sizes did LS affect N-MBW%, which was lower in a large LS. The N-MBW% was higher in healthy puppies than in those who died within one week. The ROC-derived N-MBW% thresholds were as follows: 4.5% in toy-, 3.2% in small-, 1.5% in medium-, 1.2% in large-, and 1% in giant dogs. Clinical significance. The ROC-derived N-MBW% thresholds can be used to cautiously identify puppies at increased risk for one-week mortality and may be helpful in clinical practice, representing a suitable parameter to give a prognosis on 1-week survival immediately at birth.

Apgar Score for Newborn Dog Viability Assessment: Differences between English and French Bulldogs Born via Cesarean Section

Even if largely used in canine neonatology, some questions about the Apgar Score (AS) arose. Notably, considering the breed-oriented modifications of the score are needed, slight changes of the score were reported for English (EBs) and French bulldogs (FBs). The present study aimed to evaluate the possible differences between neonatal viability of the two breeds assessed by AS in puppies born via cesarean section. The results obtained from 99 puppies born alive and without malformations (EB = 47, FB = 52) showed significant (p < 0.001) differences in the median AS (seven in EB vs. eight in FB), with Grimace (p < 0.05 for sub-score 0 and p < 0.001 for sub-score 2) and Attitude (p < 0.05) being differently sub-scored between the two breeds. In the 89 alive puppies at 7 days of age, the same difference in the median AS was observed (p < 0.001), and only Grimace was differently sub-scored between the two breeds (p < 0.05 for sub-score 0 and p < 0.01 for sub-score 2). These results suggest that low Grimace could be an intrinsic characteristic of EB newborns, but it could negatively affect the neonatal adaptation process of EBs, providing an indication for focused neonatal assistance. Neonatal mortality at 7 days of age was higher in EBs than in FBs (17 vs. 3.8%, respectively), which deserves further investigations. The study provides further evidence that breed-oriented ASs are needed for a better evaluation and assistance of purebred puppies at birth.

Determinants of Neonatal Mortality in the United States

Introduction Despite a notable reduction in infant mortality over recent decades, the United States, with a rate of 5.8 deaths per 1,000 live births, still ranks unfavorably compared to other developed countries. This improvement appears inadequate when contrasted with the country's healthcare spending, the highest among developed nations. A significant proportion of this infant mortality rate can be attributed to neonatal fatalities. Objective The present study aimed to determine the risk factors associated with neonatal deaths in the United States. Method Using the United States Vital Statistics records, we conducted a retrospective study on childbirths between 2015 and 2019 to identify risk factors for neonatal mortality. Our final multivariate analysis included maternal parameters like age, insurance type, education level, cesarean section rate, pregnancy inductions and augmentations, weight gain during pregnancy, birth weight, number of prenatal visits, pre-existing conditions like chronic hypertension and prediabetes, and pregnancy complications like gestational diabetes mellitus (GDM). These variables were incorporated to enhance our model's sensitivity and specificity. Result There were 51,174 neonatal mortalities. Mothers with augmentation of labor had a 25% reduction in neonatal mortalities (NM) (OR=0.75; 95% CI 0.72-0.79), while labor induction was associated with a 31% reduction in NM (OR=0.69; 95% CI 0.66-0.72). Women above 40 years had a 29% increase in NM rate (OR=1.29;95% CI 1.15-1.44). Women without prenatal care have a 22% increase in the risk of NM (OR=1.22; 95% CI 1.14-1.30). The present model has a 60.7% sensitivity and a 99.9% specificity. Conclusion In the present study, significant interventions such as labor induction, augmentation, and prenatal care were associated with improved neonatal outcomes. These findings could serve as an algorithm for improving neonatal outcomes in the United States.

Canine Cesarean Section: Emergency and Elective

Canine Cesarean Section (CS) is primarily performed to increase survival of newborns and less commonly to save the life or reproductive future of the dam. Conducting proper ovulation timing to accurately predict the due date will allow a planned, elective CS as an excellent alternative to a high-risk natural whelping, and possible dystocia, for certain breeds and situations. Techniques for ovulation timing, anesthesia, and surgery tips are provided.

Parameters in Canines After Cesarean Sections

This study evaluated fertility in canines after cesarean section and compared it with natural parturition. Parameters, such as the time of the next heat after the first parturition or cesarean section, the heat which was used for another breeding attempt, whether it was successful, the number of puppies that were born, and the necessity of another cesarean section were examined. The study relied on questioning patient owners at a University clinic. A Google online form was also used. Information for 261 dogs from different breed groups was included, of which 119 bitches were in the cesarean section group, and 142 were in the natural parturition group. In total, 93 ± 2.7% [LSMeans ± standard error (SE)] and 91.12 ± 3% (LSMeans ± SE) of the bitches became pregnant after cesarean section and natural parturition at the first breeding attempt. There was no significant effect on the breed group or whether the bitch had undergone a cesarean section before (p = 0.8 and p = 0.63). Bitches, which underwent a cesarean section, were more likely to have further cesarean sections performed (p < 0.001). However, neither the breed groups (p = 0.17), whether the bitch had undergone a cesarean section (p = 0.59), nor the number of previous parities had any effect on the number of puppies born (p = 0.95). The breed group bulldogs had a high proportion of cesarean sections. Only 42.11% of the bulldogs had a natural parturition as the first included parturition and only 31% gave birth naturally thereafter.

Umbilical Cord Blood Gas Parameters and Apgar Scoring in Assessment of New-Born Dogs Delivered by Cesarean Section

Simple Summary

The article presents the results of the clinical evaluation and umbilical cord blood analysis obtained from newborn pups delivered by the elective Caesarean section. In human medicine both the umbilical cord blood and Apgar score were proved to provide valuable information on neonatal status. In veterinary medicine very few reports concerning the relation between the clinical neonatal assessment (Apgar score) and umbilical cord blood parameters exist. All puppies show mild respiratory acidemia regardless the Apgar scores result. The lactates were not elevated whereas all the puppies with low Apgar sores had higher glucose and mortality rates. Only pups with low initial Apgar scores were at risk of death within first 24 h. Adaptation to the extra-uterine life is crucial and any practical improvement in neonatal diagnostics and care would be beneficial for newborn puppy survival.

Abstract

The article presents the results of the clinical evaluation (Apgar scores, AS) and umbilical cord blood gas analysis (UCBGA) obtained from clamped umbilical cords of newborn pups delivered by the elective Caesarean section. The study was planned as a controlled clinical study, the newborns were allocated into one of the groups, I—critical neonates (severe distress, AS ≤ 3), II—weak neonates (moderate distress, AS 4–6) and III—healthy neonates (no distress, AS ≥ 7). The following parameters were evaluated: pH (pH units), carbon dioxide partial pressure (pCO₂; mmHg), oxygen partial pressure (pO₂; mmHg), actual bicarbonate (cHCO₃⁻; mmol/L), total carbon dioxide (cTCO₂; mmol/L), base excess of extracellular fluid (BE(ecf); mmol/L), base excess of blood (BE(b); mmol/L), oxygen saturation (csO₂; %), lactate (Lac; mg/dL), hematocrit (Hct; %PCV), hemoglobin (cHgb; g/dL), glucose (Glu; mg/dL), ions (Na, K, Ca, Cl). The majority of puppies had low AS at birth (AS 4–6 in 38.1% and AS ≤ 3 in 57.1% of the neonates), but most of them (85.7%) improved by the 20th min. reaching AS of 7 and more. Moreover, puppies with lower AS (≤ 3) were at higher risk of death within the first 24h (20.8% did not survive). The positive correlation was found between Apgar score measured at 0 min and pH (r = 0.46, p = 0.01), and between Apgar score (at 0 min) and base excess in whole blood measured [BE(b)] r = 0.36, p = 0.03). Whereas, a negative correlation was detected between Apgar score at 0 and 5th min and glycemia (r = −0.42, p = 0.05, r = −0.34, p = 0.02 respectively. Overall, the puppies with higher glucose levels had lower Apgar scores and were at higher risk of death. Furthermore, in our study, the newborn puppies had mild acidemia with elevated pCO₂ levels and the HCO₃ at the lower range of normal limits, suggesting the mixed component in the acidemic state. Adaptation to extra-uterine life is crucial and any practical improvement in neonatal diagnostics and care would be beneficial for newborn puppy survival.

Pre- and Probiotics to Increase the Immune Power of Colostrum in Dogs

Wide differences in Ig concentration in canine colostrum have been reported. Thus, some litters can be at risk of passive immune transfer failure. Present study evaluated if supplementation with MOS, FOS, E. faecium and L. acidophilus along pregnancy increases colostrum quality. Twenty Great Dane bitches were divided into 4 groups. Control group (CG) received standard diet, only. Diet was supplemented with pre- and probiotics in other 3 study groups during: the last (1WG), last 2 (2WG), and last 4 (4WG) weeks of pregnancy, until parturition. Serum samples were collected at estrous (T0), supplementation beginning (T1), and parturition (T2). Colostrum was collected at C-section end. The IgG, IgM, and IgA were assayed on both matrices. In serum, IgG were higher at T0 than at parturition in all study groups and they significantly lowered from T0 to T1 in all groups. In colostrum, IgG and IgM were significantly higher in 4WG, while IgA already increased in 2WG group. Four-week pre- and probiotic supplementation resulted in the best immune properties of colostrum, as by the higher IgG, IgM, and IgA colostrum levels found in 4WG. Further studies would verify the exact mechanisms involved: pre-partum IgG mammary accumulation and B-cells GALT proliferation and mammary transfer. Further trials would verify whether these beneficial effects of pre- and probiotics on colostrum also lead to improved clinical conditions and immunological functions of newborns and puppies.

A Biotic Support During Pregnancy to Strengthen the Gastrointestinal Performance in Puppies

Up to 60% of neonates can be affected by gastroenteritis due to specific pathogens or aspecific polymicrobial interactions. The present study evaluated if a dietary supplementation with MOS, FOS, E. faecium and L. acidophilus in pregnancy may reduce gastroenteritis in puppies. Fifteen Great Danes were divided in 3 groups. The control group (CG) ate a standard diet. In 2 study groups, the diet was supplemented with pre- and probiotics during the last (1WG) and the last 4 pregnancy weeks (4WG). Up to 9 weeks, puppies were checked daily to identify first- or second- presentation gastroenteritis. Data were processed by χ² (P < 0.05). First-presentation gastroenteritis was more frequent in CG than in 1WG than in 4WG. Second-presentation gastroenteritis was more frequent in CG than in 1 and 4WG. Puppies from pre- and probiotics supplemented bitches were less prone to gastroenteritis. 1 or 4WG equally reduced second-presentation gastroenteritis in puppies, but 4WG was better than 1WG on first-presentation gastroenteritis. By entero-mammary link, supplemented bitches produced higher immune quality colostrum, thus puppies faced immunitary challenges better; moreover, maternal microbiota, positively altered by supplementation, was transferred to newborns, becoming more resistant to gastroenteritis. This information can be useful in clinical practice with the goal of preventing gastroenteritis in puppies and reducing its prevalence and severity.

Apgar score or birthweight in Chihuahua dogs born by elective Caesarean section: which is the best predictor of the survival at 24 h after birth?

Background

In the dog, the correct management of parturition and the prompt neonatal evaluation and assistance can reduce the perinatal mortality rates that are particularly high in toy breeds. Newborn evaluation and factors addressing prognosis are pivotal to guarantee the correct neonatal assistance. Assessment of the Apgar score with viability classification and birthweight are recognized as predictors for neonatal survival in dogs, but breed-specific data are needed for a more feasible application in the dog species, in which wide differences among breeds are known. The present study aimed therefore to: (a) assess the role of Apgar score and birthweight as predictors for the survival of Chihuahua newborn puppies in the first 24 h of life; (b) to assess a cut-off of the Apgar score and birthweight values that can predict the survival of Chihuahua newborn puppies in the first 24 h after birth; (c) to assess the possible effect played by maternal parity, newborn gender and litter-size on Apgar score in Chihuahua newborn puppies, in order to provide breed-specific data for a better neonatal assistance.

Results

Data obtained from 176 normal developed Chihuahua puppies born by elective Caesarean section, showed that 62%, 28% and 10% of puppies were classified in the Apgar score classes 7–10, 4–6 and 0–3, respectively, with survival at 24 h after birth of 97%, 96%, 39%, in the three Apgar classes of viability, respectively. Apgar score was a better predictor for survival at 24 h after birth than birthweight (AUC 0.93, P < 0.0001; AUC 0.69, P < 0.01, respectively). Litter-size of 7 puppies/litter plays a negative effect on Apgar score. Apgar score is a better predictor of survival at 24 h than birthweight, and the best cut-off of Apgar score for survival at 24 h after birth is 4, with 96% sensitivity and 77% specificity.

Conclusions

The different proportion of “normal viable” and “less viable” neonates in comparison to other studies highlights that Chihuahua puppies born by elective Caesarean section should be carefully evaluated at birth to provide correct assistance.

Urinalysis in Great Dane Puppies from Birth to 28 Days of Age

Simple Summary

Still, nowadays, small animal perinatology is quite an unknown field of veterinary medicine. To help decrease the high mortality rates reported for canine newborns, veterinary practitioners should become more aware of neonatal physiology and pathology, focusing their attention on metabolic balance. It is impossible to discriminate healthy puppies from pathological littermates in the absence of reference ranges for specific parameters, which are obviously different from those of adults. Since blood samples are more difficult and dangerous to collect from newborns, practitioners could rely on urinary samples, easily gathered by the stimulation of the somato-vesical spinal reflex. The present research, based on 624 urine samples, offers results that can be used as references for the first-line evaluation of newborn Great Danes by dipstick rapid urinalysis. In healthy puppies, specific gravity and pH vary from birth to 28 days of age, while glucosuria and proteinuria are never reported. The present results, derived from a sample of single-breed puppies, can represent the starting point for a further multi-breed evaluation.

Abstract

Urinalysis, a common test in infants, could represent a suitable non-invasive clinical tool in puppies. In dog neonates, urine is easily collected by stimulating the somato-vesccal reflex. Information on urine characteristics during the neonatal period is missing. Beside instrumental laboratory analyses, the dipstick was proven useful for rapid urinalysis to evaluate specific gravity (SG), pH, leukocytes, nitrites, glucose, proteins, ketones, urobilinogen, bilirubin, and blood. The present study aimed to describe urinalysis features by the dipstick test and refractometer along the neonatal period. Urine samples (n = 624) were collected by manual stimulation from 48 healthy Great Danes, daily from birth to seven days, then twice a week until 28 days, to assess age-related changes (ANOVA, p < 0.05) and the possible effects of gender and litter (T-test, p < 0.05). The SG and pH significantly changed during the neonatal period. Other parameters did not vary significantly in relation to age. No significant differences were observed either among litters or between genders. The present study confirmed that canine kidneys are able to concentrate urine from the second week of age when the urinary SG started to be similar to adults, while pH still increased towards the typical values of adults at 28 days. Significant glucosuria and proteinuria were never detected. Dipstick urinalysis represents a useful first-line complementary tool in newborns clinical examination, providing information about systemic homeostasis.

Fertility outcome after medically treated pyometra in dogs

Cystic endometrial hyperplasia-pyometra complex (CEH/P) is a challenge in canine reproduction. Present study aimed to assess fertility after medical treatment. One-hundred-seventy-four bitches affected by CEH/P received aglepristone on days 1, 2, 8, then every 7 days until blood progesterone < 1.2 ng/mL; cloprostenol was administered on days 3 to 5. Records were grouped according to bodyweight (BW): small (< 10 kg, n = 33), medium (10 ≥ BW < 25 kg, n = 44), large (25 ≥ BW < 40 kg, n = 52), and giant bitches (BW ≥ 40 kg, n = 45). Age; success rate; aglepristone treatments number; relapse, pregnancy rates; diagnosis-relapse, -first, -last litter intervals; litters number after treatment, and LS were analyzed by ANOVA. Overall age was 5.14 ± 1.75 years, without difference among groups. Treatment was 100% successful, without difference in treatments number (4.75 ± 1.18), relapse (15/174, 8.62%) and pregnancy (129/140 litters, 92.14%) rates, intervals diagnosis-relapse (409.63 ± 254.9 days) or -last litter (418.62 ± 129.03 days). The interval diagnosis-first litter was significantly shorter (163.52 ± 51.47 days) and longer (225.17 ± 90.97 days) in small and giant bitches, respectively. Overall, 1.47 ± 0.65 litters were born after treatment. Expected LS was achieved in each group, as shown by ΔLS (actual-expected LS by breed, overall -0.40 ± 1.62) without differences among groups. Concluding, CEH/P affects younger dogs than previously described. Relapses were rarer than previously reported. Medical treatment with aglepristone+cloprostenol is effective and safe, preserving subsequent fertility, as demonstrated by negligible changes in LS.

Effects of Alfaxalone or Propofol on Giant-Breed Dog Neonates Viability During Elective Caesarean Sections

Attention must be paid to C-section anesthesia effects on mother and offspring. Alfaxalone induction results in improved puppy viability when compared to propofol. The present study aims to evaluate effects of alfaxalone or propofol induction for elective C-section on newborns, expressed as Apgar score and fetal fluids cortisol concentration. Anesthesia was induced with alfaxalone 3 mg/kg iv in 5 bitches (group A), and propofol 4 mg/kg iv in another 5 (group P), maintained with isoflurane. Amniotic and allantoic fluids were collected to determine cortisol concentration. Apgar score, litter size, newborn gender, birth-weight, maternal age, and parity were recorded. ANOVA, U Mann-Whitney test and ANCOVA assessed the effects of drugs on the Apgar score and fetal fluids cortisol. Thirty-six puppies were randomly selected for the study: 16 from group A and 20 from group P. Only the Apgar score significantly differed between groups. ANCOVA confirmed a significantly higher Apgar score in group A underlining the influence of fetal fluids cortisol concentrations, both resulting in covariates. Present results confirm the effect of anesthesia on the Apgar score of newborns, which is significantly higher for alfaxalone than propofol, suggesting the use of fetal fluids cortisol as a covariate. These findings could be a starting point for further investigations when less viable puppies are detected or expected, such as during an emergency C-section.