Pediatric intensive care

Fading kitten syndrome: Factors predisposing to 'faders' and treatment options

PRACTICAL RELEVANCE

Fading kitten syndrome is a condition where one or more kittens of a litter are born apparently healthy but gradually become inactive, sick and die; typically faders are considered those that die during the first 2 weeks of life. Fading has many potential aetiologies, including a wide variety of infectious, toxic, traumatic, metabolic and genetic diseases. Regardless of the underlying cause, the approach to a sick neonate is similar, and initiating supportive care is the first priority, followed by a detailed physical examination. Where possible, the cause of disease should be determined, and this may inform adjustments to the treatment protocol.

CLINICAL CHALLENGES

Most perinatal and neonatal diseases present similarly and a specific cause cannot usually be determined from clinical signs alone, which can make diagnosis challenging. When examining a kitten, it is important to remember that there are distinct physiological differences between adults and neonates. In addition, some procedures can be more difficult to perform than in adults, such as blood collection, and some diagnostic tests are harder to interpret, such as radiography. When treating kittens, differences compared with adults again need to be considered.

AIM

The aim of this review is to provide guidance to veterinarians who are presented with a fading kitten. As well as reviewing the potential causes of fading kitten syndrome, the diagnostic approach and treatment options are discussed. Algorithms summarising possible pathways to neonatal mortality in kittens, and diagnostic and therapeutic options in fading kittens, are also provided.

EVIDENCE BASE

Information provided in this review is based on the published feline literature and papers discussing puppies and/or a range of species including cats, as well as the author's own clinical experience.

Haematological and biochemical analysis of healthy neonatal puppies during the immediate foetal-to-neonatal transition

For the neonatal patient, precocity of diagnosis is crucial for effectiveness of medical approach. However, the newborn has its own physiological peculiarities due to ongoing adaptive mechanism for extrauterine life and deserves special attention in order to underline a specific management or clinical approach. The objective of this work was to verify clinical adaptations and biochemical balance of neonates during immediate period, with special reference to haematological, renal and metabolic functions. Neonatal puppies (n = 51) were physically examined for vitality and rectal temperature at birth, 5 and 60 min post-birth. Blood was collected at birth and 60 min post-birth for analysis of glucose, sodium, potassium, chlorine, blood urea nitrogen (BUN), haematocrit and haemoglobin. Neonatal vitality was lower at birth compared with 5 min and 60 min post-birth. Progressive decline in rectal temperature (36.5 ± 0.3°C, 34.2 ± 0.2°C, 32.3 ± 0.5°C) was observed at birth, 5 min and 60 min post-birth, respectively. Puppies presented slight hyponatremia (140.7 ± 0.5 mmol/L) at birth and hypopotassemia (3.5 ± 0.1 mmol/L) and blood urea nitrogen (13.1 ± 0.7 mg/dl) during the first hour, and high haematocrit (45.1 ± 1.0%) and haemoglobin (15.3 ± 0.3 g/dl) concentration. In conclusion, puppies had rapid evolution of vitality. Marked decrease in rectal temperature occurred at 5 min post-birth. Haematological values of neonates immediately after birth reflected mainly the dam's blood status, not being useful for a blood panel at this time point. The peculiar pattern of BUN, sodium and potassium observed during transition period, suggested that specific reference range should be considered for neonatal puppies.

The Association of Shelter Veterinarians' 2016 Veterinary Medical Care Guidelines for Spay-Neuter Programs

As community efforts to reduce the overpopulation and euthanasia of unwanted and unowned cats and dogs have increased, many veterinarians have increasingly focused their clinical efforts on the provision of spay-neuter services. Because of the wide range of geographic and demographic needs, a wide variety of spay-neuter programs have been developed to increase delivery of services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, community cat programs, and services provided through private practitioners. In an effort to promote consistent, high-quality care across the broad range of these programs, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. These guidelines consist of recommendations for general patient care and clinical procedures, preoperative care, anesthetic management, surgical procedures, postoperative care, and operations management. They were based on current principles of anesthesiology, critical care medicine, infection control, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs regardless of location, facility, or type of program. The Association of Shelter Veterinarians envisions that these guidelines will be used by the profession to maintain consistent veterinary medical care in all settings where spay-neuter services are provided and to promote these services as a means of reducing sheltering and euthanasia of cats and dogs.

Alternative Access Routes for Fluid Resuscitation

Fluid resuscitation in small animals is important in emergency situations and is utilized by every veterinary practice. Peripherally inserted intravenous catheters are an effective way of giving fluids to a veterinary patient. If an intravenous catheter is not obtainable, there are multiple other ways to administer fluids to a patient including dorsal pedal catheters, intraosseous catheters, central venous catheters, peripherally inserted central catheters, nasogastric tubes, nasoesophageal tubes and subcutaneous administration of fluids. This article will discuss the advantages and disadvantages of each way of administration.

Playing mum: successful management of orphaned kittens

PRACTICAL RELEVANCE

Orphaned kittens are common and veterinary team members should be prepared to assist owners in providing appropriate care. If a foster queen is not available, the physiologic needs normally provided by the queen, such as warmth, nutrition, elimination, sanitation and social stimulation, must be replaced. Specialized knowledge of physiology and nutritional requirements is necessary for successful management in this age group.

CLINICAL CHALLENGES

The condition of neonatal kittens can deteriorate rapidly and orphans may have an even higher risk of illness than kittens cared for by a healthy queen. Thus an increased level of veterinary care and monitoring is required. Rapid recognition and correction of problems can only be accomplished through detailed observation and knowledge of developmental milestones. Survival may be dependent on treatment that compensates for the failure of passive transfer of immunity.

AUDIENCE

This review is addressed at veterinarians and all veterinary team members, as well as care-givers such as rescuers and shelter workers.

EVIDENCE BASE

The guidance contained in this article is based on a combination of published literature, the author's personal experience and the experience of colleagues.

Age-related changes in biochemical and hematologic variables in Borzoi and Beagle puppies from birth to 8 weeks

BACKGROUND

Nonspecific signs of illness and availability of only limited information about expected biochemical and hematologic values in puppies make formulation of a differential diagnosis challenging for veterinarians.

OBJECTIVES

The objectives of this prospective study were to describe age-related changes in biochemical and hematologic variables in Borzoi and Beagle puppies from birth to 8 weeks and to compare results with adult reference intervals (RIs).

METHODS

Biochemical and hematologic analytes in blood collected in heparin and EDTA from 31 clinically healthy puppies (21 Beagle and 10 Borzoi dogs) were measured or calculated each week from birth to 8 weeks of age. RIs were calculated using the parametric robust method after Box-Cox transformation.

RESULTS

There were no significant differences between values of puppies and adults for ALT activity, glucose concentration, MCHC, WBC count, and platelet count. Total protein concentration, RBC count, and HCT were lower and creatine kinase activity was higher in puppies of all ages compared with these variables in adults. Compared with adult RI, in puppies urea concentration was higher at birth and week 1, creatinine concentration was lower at weeks 1-5, ALP activity was higher at all weeks except for weeks 4 and 6, hemoglobin concentration was lower at weeks 1-8, MCV was higher at birth and week 1, and reticulocyte count was higher at all weeks except week 1. Statistically, mixed models accounted for evaluation of the same puppies each week and in most cases demonstrated an effect of age and sometimes breed. Some reference intervals should be used with caution owing to potential outliers. The 90% confidence intervals exceeded those recommended by the International Federation of Clinical Chemistry.

CONCLUSIONS

Clinicians should be aware of temporal changes in biochemical and hematologic values for puppies during the first 2 months of life to avoid misinterpretation of results.

An Apgar scoring system for routine assessment of newborn puppy viability and short-term survival prognosis

The Apgar scoring system is an easy and reliable method for evaluating both human and animal neonates. However, its use is not widespread in veterinary medicine. The current study assessed a modified Apgar scoring system for routine evaluation of newborn puppies. Heart rate, respiratory effort, reflex irritability, motility, and mucus color have been evaluated in the score. Specifically, we used 5 min after birth Apgar score to assess newborn viability and short-term survival prognosis, as well as related characteristics, in 193 puppies from 42 litters, 65 born by spontaneous delivery, 66 by assisted delivery, and 62 by cesarean section. The percentage of puppies that were dead 2h after birth was higher in the 4 to 6 Apgar score group versus that in the 7 to 10 score group (P<0.01) and in the 0 to 3 score group versus that in the 7 to 10 score group (P<0.0001). Delivery method did not affect survival. There was a marked reduction in the number of puppies searching for the mammary gland in the 0 to 3 and 4 to 6 Apgar score groups compared with that in the 7 to 10 score group (P<0.0001); there was a difference between the 0 to 3 and the 4 to 6 score groups as well (P<0.05). Suckling/swallowing reflexes were present in fewer puppies in the 0 to 3 and 4 to 6 score groups compared with that in the 7 to 10 group (P<0.0001), with no significant differences between the 0 to 3 and the 4 to 6 score groups.

The Association of Shelter Veterinarians veterinary medical care guidelines for spay-neuter programs

As efforts to reduce the overpopulation and euthanasia of unwanted and unowned dogs and cats have increased, greater attention has been focused on spay-neuter programs throughout the United States. Because of the wide range of geographic and demographic needs, a wide variety of programs have been developed to increase delivery of spay-neuter services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, feral cat programs, and services provided through private practitioners. In an effort to ensure a consistent level of care, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. The guidelines consist of recommendations for preoperative care (eg, patient transport and housing, patient selection, client communication, record keeping, and medical considerations), anesthetic management (eg, equipment, monitoring, perioperative considerations, anesthetic protocols, and emergency preparedness), surgical care (eg, operating-area environment; surgical-pack preparation; patient preparation; surgeon preparation; surgical procedures for pediatric, juvenile, and adult patients; and identification of neutered animals), and postoperative care (eg, analgesia, recovery, and release). These guidelines are based on current principles of anesthesiology, critical care medicine, microbiology, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs.

Pediatric fluid therapy

Many conditions of pediatric patients require fluid therapy. Depending on the veterinarian's assessment of hydration and perfusion status, fluids can be administered orally, subcutaneously, intraperitoneally, intravenously, or by the intraosseous route. Pediatric patients are prone to hypothermia, hypovolemia, hypoglycemia, and hypokalemia, which must be addressed during fluid therapy in pediatric patients. Typical parameters used to assess hydration status in adult animals do not always apply to pediatric patients. Veterinarians should be aware of differences between pediatric patients and adult animals in terms of physical assessment, common presentations, and fluid requirements for resuscitation and maintenance needs.