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

Apgar scores in puppies following the induction of etomidate compared with alfaxalone or propofol for cesarean section

Background and Aim

The Apgar score is a useful assessment of neonatal viability in dogs. The Apgar score in puppies born by cesarean section can be lower than vaginal delivery because all anesthetic drugs can cross the placenta. Therefore, anesthetic drugs with minimal cardiorespiratory effect and rapid elimination are recommended for cesarean section. The present study aimed to compare Apgar scores in puppies born after the induction of etomidate, alfaxalone or propofol, and those maintained with isoflurane inhalation during cesarean section.

Materials and Methods

Thirty-six bitches were equally divided in the three anesthetic drug groups. Modified Apgar scores were assessed at 5, 15, and 60 min after delivery. Intraoperative vital signs and Apgar scores were compared using a linear mixed model and adjusted pairwise comparisons using Bonferroni analysis.

Results

A total of 125 puppies were included in this study. Age, body weight, litter size, type of surgery, delivery time, anesthetic and surgical duration, and intraoperative vital signs did not significantly differ between the groups. Puppies in the alfaxalone and propofol groups had significantly higher Apgar scores than the etomidate group in both elective and emergency surgery. In elective surgery, Apgar scores at 5 min after delivery did not differ significantly between groups. At 15 and 60 min after delivery, Apgar scores in the etomidate group were significantly lower than those in the other groups. In emergency surgery, Apgar scores were significantly lower in the etomidate group than in the alfaxalone group at all time points.

Conclusion

Induction with alfaxalone and propofol resulted in better outcomes with higher Apgar scores and neonatal viability than etomidate. Therefore, alfaxalone and propofol should be used as anesthetic induction drugs in both elective and emergency cesarean sections.

Preparation and exchange transfusion effect of a double polymerization human umbilical cord haemoglobin of red blood cell substitute

The development of haemoglobin-based oxygen carrier (HBOC) is an excellent supplement to pre-hospital emergency blood transfusions. In this study, a new type of HBOC was prepared by using human cord haemoglobin (HCHb) and glutaraldehyde (GDA) and Bis(3,5-dibromosalicyl) fumarate (DBBF) to modify (DBBF-GDA-HCHb), the changes of physicochemical indexes during its preparation were evaluated, while a traditional type of GDA-HCHb was prepared, and the oxygen-carrying capacity of two type of HBOC was evaluated by a rat model of 135.0% exchange transfusion (ET). Eighteen SD male rats were selected, and were randomly divided into control group (5.0% albumin), DBBF-GDA-HCHb group and GDA-HCHb group. The 12 h survival rate of the C group was 16.67%, and the two HBOC groups were both 83.33%. Compared with GDA-HCHb, DBBF-GDA-HCHb can reduce lactic acid content by supplying oxygen to hypoxic tissues in a more timely manner, and can also can improve the reduction of MAP due to ischaemia.

Emergency cesarean section in dogs: Usefulness of amniotic fluid biochemical parameters and placental morphology as indicators of neonatal viability

In recent years, special attention has been paid to the analysis of fetal fluids and placental histopathology to identify parameters that can be used as indicators of maternal reproductive quality, embryonic viability, and fetal and neonatal health. Newborn health reflects the functioning of the fetal adnexa and its relationship with maternal tissues. Therefore, evaluating these components is promising for the early detection of newborns at risk. This study aimed to detect the biochemical characteristics of the amniotic fluid (AF) and histopathological characteristics of the placenta for comparison between canine neonates born by elective (EL) and emergency (EM) cesarean sections (CSs) and associate the results with neonatal viability in the first 24 h. A total of 38 neonates born by ELCS (n = 19) and EMCS (n = 19) were selected. AF was collected to analyze the concentration of its biochemical components [alanine aminotransferase (ALT), alkaline phosphatase (ALP), creatinine, urea, total protein, albumin, total and direct bilirubin, lactate, glucose, potassium, chloride, calcium, and sodium]. Histopathological processing of the placenta was used to describe the lesions and identify the arrangement of collagen fibers using hematoxylin-eosin and picrosirius staining. There was an increase in ALP activity (P = 0.035) and the concentrations of lactate (P < 0.001) and potassium (P = 0.031), and a decrease in chlorides (P < 0.001) in the AF of neonates in the EMCS group. The comparisons between the groups did not show differences between the presence and extent of lesions in the placenta; however, a difference was observed in the arrangement of collagen fibers in the placental structure. A comparison between AF and histopathological findings showed a negative correlation (r = -0.609, P = 0.003) between glucose concentration and the presence of necrosis in the placental labyrinth. It was observed that the composition of the AF changed owing to the influence of the type of cesarean, possibly caused by prolonged hypoxia in cases of dystocia. ALP activity and lactate, potassium, and chloride concentrations in the AF might be explored as markers of neonatal health in EMCS. Under the conditions of this study, no correlations were found between the placenta's histopathological characteristics and the neonates' viability.

Canine Neonatal Health

This article provides a high-level overview of canine neonatal health for clinicians to use as a mental framework so that when presented with a canine neonate it is easier to construct a logical and systematic clinical approach that is less overwhelming. As early detection of the at-risk neonate results in earlier intervention, and improved health outcomes, there will be a focus on pro-active care. Where appropriate, other articles in this issue will be mentioned for a more in-depth discussion of specific areas. Key points will be highlighted throughout the text.

Comparison of 2 anesthetic protocols and surgical timing during cesarean section on neonatal vitality and umbilical cord blood parameters

BACKGROUND

The objective of this study was to evaluate the relationship between the mode of anesthesia, the time form the induction to the extraction of a puppy and the immediate postnatal vitality and umbilical cord blood gases parameters in cesarean section derived-puppies. Two different anesthetic protocols were used: inhalation using isoflurane (ISO) and combined-inhalation and epidural (EPI) with propofol being the induction agent.

RESULTS

Significant differences were found in ISO group in pH values, pCO2 levels and Apgar scores between puppies at different extraction times (< 30 vs. ≥ 30 min). In ISO group puppies extracted later were more acidic (7.16 vs. 7.22), had higher levels of pCO2 (69 vs. 57 mmHg) and lower Apgar scores at birth (1.2 vs. 2.5). On the contrary, in EPI group no differences were observed between the delivery time, umbilical blood gas parameters and puppies' vitality. Furthermore, the dams from the EPI group required lower concentrations of isoflurane (MAC 1.11 ± 0.19 vs.1.37 ± 0.16, p < 0.001).

CONCLUSIONS

Multiple pregnancies frequent in dogs lead to significant differences in extraction times between the first and the last puppy during cesarean section. Obtained results showed that the mode of anesthesia and the surgical time would influence the neonatal outcome during cesarean section in dogs. The higher concentration of isoflurane with the longer time of exposure had a negative effect on the initial newborn vitality as well as the umbilical cord blood gas parameters. Therefore, when performing CS in giant dog breeds or expecting many puppies in the litter, it is worth considering epidural component that allow for lower concentrations of inhalant agents, which may contribute to a better clinical condition of newborns.

Biochemical factors affecting newborn survival in dogs and cats

The importance and implications of small animal neonatology were underestimated until recent times. Despite the recent increasing interest for this branch of veterinary medicine, however, perinatal mortality rates in canine and feline species remain high, representing an important challenge for the clinician. In this perspective, the prompt identification of newborns requiring additional and tailored assistance becomes a key to reduce the perinatal losses in small animals. To achieve this goal, clinical and laboratory findings must be carefully evaluated. This paper focuses on biochemical parameters and their reported influence on neonatal survival, guiding through the evaluation of canine and feline newborn laboratory analyses, with a thorough discussion about the use of different biological material in these subjects. Beside blood, other biological material, such as urines and fetal fluids proved to be interesting for the identification of possible prognostic markers, thanks also to their easy and safe collection. However, the correct reading-through the results must consider many variables such as type of delivery, anesthesia protocol in case of Caesarean section, age of the newborn at samples collection, and for blood analysis, also the type of blood, site of collection, modality of collection and storage must be considered. Notwithstanding the recent progress in literature, for most of the parameters more research is needed to define cut-off values with certainty.

Preliminary study on fluid bolus administration for prevention of spinal hypotension in dogs undergoing elective cesarean section

Introduction

This study aimed to investigate the effect of fluid bolus administration during epidural anesthesia (coload) in female dogs scheduled for elective cesarean section (CS). Hypotension is one of the most common complications of epidural (EA) and spinal (SA) analgesia, and in the case of cesarean section, it may pose a significant risk for placental perfusion and subsequent fetal vitality and puppy survival.

Methods

Pregnant bitches scheduled for elective CS underwent EA with (treatment group) or without (control group) intravenous fluid bolus administration. The following parameters were measured and compared between both groups: HR, RR, etCO₂, SpO₂, systolic, diastolic and mean arterial blood pressure were measured at three time points (T1: before surgery, T2: after the last puppy removal, and T3: end of surgery) in dams; vitality (Apgar score at 0, 5, and 20 min) and umbilical cord blood parameters (pH, pCO2, HCO3, base excess, lactate and glucose) in newborns.

Results

The results indicated that crystalloid coloading increased maternal systolic, diastolic, and mean blood pressure (treatment vs. control group, 101.46 ± 9.18, 48.01 ± 13.47, and 67.07 ± 13.15 mmHg vs. 80.68 ± 7.29, 36.52 ± 8.75, and 180 52.30 ± 7.77, p < 0.05) with significantly fewer episodes of hypotension. Additionally, puppies in the treatment group received higher scores in the 5-min (7.91 ± 1.67 vs. 6.74 ± 2.20) and 20-min (9.38 ± 0.87 vs. 8.39 ± 2.50) assessments without the favorable effect on umbilical blood gas parameters.

Discussion

Based on the obtained results, it can be stated that crystalloid coload offers an effective option in cases of hypotension during cesarean section, with clear benefits for both mothers and newborns.

Is an epidural component during general anaesthesia for caesarean section beneficial for neonatal puppies' health and vitality?

Regional centro-axial block is a recommended technique for uncomplicated caesarean section in human medicine. Since the application of regional anaesthesia as the only technique in veterinary medicine is impractical, the objective of the study was to assess and compare the epidural component of caesarean section (CS) on maternal and fetal outcomes. Bitches (n = 36) undergoing elective CS were enrolled in this study. Females were randomly assigned into two groups: Gr I (Isoflurane, n = 20) and Gr IE (Isoflurane plus Epidural, n = 16). Anaesthesia was induced with propofol, and maintained with isoflurane in oxygen. In the IE group, epidural anaesthesia was also performed using lidocaine. The maternal intraoperative parameters were compared at three time points: T1 - just before the skin incision, T2 - after the last puppy removal, and T3 - at the end of surgery. At least 100 mcl of mixed umbilical cord blood was collected for gas analysis. The modified Apgar scoring system (AS) was used to objectively score newborn health and vitality immediately after birth (0 min), 5 and 20 min after birth. Systolic, diastolic, and mean blood pressure were lower in the IE group at T1, T2, and T3 compared to I group (p < 0.05). In the combined anaesthesia group blood pressure remained stable but low at all time points. Throughout surgery, the IE group required a lower concentration of isoflurane (p < 0.05). The median values of the umbilical blood gas results were found to be similar (p > 0.05) in both investigated groups. The initial results of the Apgar score were comparable in the I and IE groups (p > 0.05). However, subsequent AS measurements revealed significant differences between both groups. Puppies from the IE group received better AS scores at 5 and 20 min compared to the I group (median AS 8 and 9 vs. 5 and 8, respectively). The results obtained demonstrated that epidural anaesthesia administration reduced the requirement for isoflurane in dams undergoing caesarean section and despite episodes of maternal hypotension did not affect the results of neonatal umbilical blood gas. Furthermore, newborns from the epidural anaesthesia group improved more quickly postnatally, developing a satisfactory condition in a shorter time.

Refining the APGAR Score Cutoff Values and Viability Classes According to Breed Body Size in Newborn Dogs

The Apgar score (AS) represents a key tool for neonate assessment, but the possible breed effect on AS in newborn puppies has never been investigated. Therefore, data from 234 dog litters born by caesarean section, grouped according to breed body size (BBS) (small, medium, large), were evaluated. Live-birth puppies were assessed through AS within 5 min of delivery, and classified in viability classes: 0−3 severely distressed, 4−6 moderately distressed, 7−10 not distressed. Statistical analysis evaluated possible differences of AS and viability class according to BBS, and between BBS and puppies’ mortality. Results showed no differences in the distribution of mortalities among BBSs. However, an effect of BBS on the AS was found, with small-sized puppies being the most represented in the severely distressed class, but having the best survival chance compared to large-sized newborns. Through receiver-operating-characteristics analysis, the AS new cutoff values for survival and for death <24 h and 24 h−7 days of age were identified, and the viability classes were redefined, with a narrower class of moderately distressed puppy specific for each BBS. In conclusion, the refining of the AS in dog species is imperative, with cutoff values and viability classifications that must be adapted to the BBS.

Dead or Alive? A Review of Perinatal Factors That Determine Canine Neonatal Viability

Simple Summary

The article summarizes the current knowledge on factors related to pregnancy, parturition, and newborns that affect the health status of a puppy and determine its chances for survival and development. The detailed information is provided in terms of breed predispositions, objectives of pregnancy monitoring, potential sources of complications, and veterinary advances in care and treatment of perinatal conditions. Successful pregnancy outcomes still pose challenges in veterinary neonatology; thus, publications presenting the current state of knowledge in this field are in demand.

Abstract

The perinatal period has a critical impact on viability of the newborns. The variety of factors that can potentially affect the health of a litter during pregnancy, birth, and the first weeks of life requires proper attention from both the breeder and the veterinarian. The health status of puppies can be influenced by various maternal factors, including breed characteristics, anatomy, quality of nutrition, delivery assistance, neonatal care, and environmental or infectious agents encountered during pregnancy. Regular examinations and pregnancy monitoring are key tools for early detection of signals that can indicate disorders even before clinical signs occur. Early detection significantly increases the chances of puppies’ survival and proper development. The purpose of the review was to summarize and discuss the complex interactions between all elements that, throughout pregnancy and the first days of life, have a tangible impact on the subsequent fate of the offspring. Many of these components continue to pose challenges in veterinary neonatology; thus, publications presenting the current state of knowledge in this field are in demand.

Canine Neonatal Assessment by Vitality Score, Amniotic Fluid, Urine, and Umbilical Cord Blood Analysis of Glucose, Lactate, and Cortisol: Possible Influence of Parturition Type?

Simple Summary

Parturition as a stressful event may influence puppies’ neonatal morbidity and mortality. The purpose of this study was to investigate the impact of parturition type on stress in newborn puppies, their weight gains, and survival in the first week postpartum. One hundred and twenty-three puppies were divided into three groups: vaginal parturition, emergency, and elective cesarean section. The Apgar score was assessed 5, 15, and 60 min postpartum, and samples of amniotic fluid, umbilical blood, and urine were collected for lactate, glucose, and cortisol concentration measurements. Although emergency cesarean section puppies had the highest cortisol concentration of all groups, their Apgar score at 5 min postpartum was comparable to the vaginal parturition group, which had the highest lactate levels. There were no significant differences between groups regarding relative growth rate. The type of parturition had no impact on puppies’ survival in our study, but supportive treatment was provided for non-vital puppies in stress. Non-invasive analysis of amniotic fluid and/or urine could help in the assessment of the neonatal vitality.

Abstract

The objective of this study was to investigate the impact of parturition type on vitality in newborn puppies, their weight gains, and survival in the first week postpartum. One hundred and twenty-three puppies were divided in three groups: vaginal parturition (VP), emergency (EM-CS), and elective cesarean section (EL-CS). Apgar scores were assessed 5, 15, and 60 min postpartum. Lactate and glucose concentrations were measured in amniotic fluid and umbilical blood; cortisol concentrations were measured in amniotic fluid and puppy urine. Puppies’ weight gain was tracked daily for 7 days postpartum. Apgar score at 5 and 15 min was significantly better in the VP group. EL-CS puppies had significantly lower umbilical blood and amniotic fluid lactate concentrations compared to the VP group, which also had higher umbilical blood lactate concentration than EM-CS puppies. The cortisol concentration in the amniotic fluid and in urine differed significantly between the groups, with the highest concentration in the EM-CS, followed by the VP group. Glucose concentration in amniotic fluid was higher in the VP group than EM-CS group. The type of parturition had no impact on puppies’ weight gain or their survival at birth; however, supportive treatment was provided for non-vital puppies. Non-invasive analysis of puppies’ fluids could help in the assessment of the neonatal vitality.