Kittens - caring for the newborn

Hypoxia or anorexia is a common cause of death in neonates (see fading kitten syndrome). Immediately following parturition (whether by natural delivery or cesarean section), several procedures should be performed. The airway should be cleared and free of any membranes from the placenta, fluid, and meconium within 1-3 min of birth. The placental membranes should be torn and removed quickly from around the head, especially those covering the openings of the nostrils. Quickly afterward, fluid should be gently suctioned and swabbed from the mouth and opening of the throat. Thereafter, fluid can be expelled from the upper and lower airways by gently swinging the neonate headfirst in a downward path while supporting its head and trunk in a dry, warm towel. If respiration does not begin spontaneously, chest and facial massage with a dry, warm towel may be needed. Effects of narcotics or barbiturates used during cesarean section may be reversed by instilling one to two drops of naloxone or doxapram onto the tongue and roof of the mouth of the neonate. If the neonate is still unresponsive, oxygen is provided through a facemask.

Cardiac arrest or a failing heartbeat generally follow poor respiration that does not respond to treatment. If no heartbeat is detected, the chest is massaged in the area of the heart. If the heart rate is <60 bpm, diluted epinephrine may be placed into the throat or mouth. However, these neonates rarely survive.

Hypothermia develops if external warming is not provided immediately after birth. Neonates should be quickly dried after birth and kept warm. Room temperature should be ~84-86°F (28.9-30°C).

Puppies and kittens should be checked for GI parasites at ~3 wk and dewormed at regular intervals—every other week until they reach 2 mo of age, then monthly until they reach 6 mo of age. Heartworm preventive medication should be started at 6-8 wk of age in areas where heartworm disease is endemic. The initial vaccination series for puppies and kittens usually begins at 6 wk of age with boosters given at 9 wk, 12 wk, and sometimes 15 wk.

Bacterial infections

The bacterial invasion of the bloodstream that is regularly seen in puppies and kittens after birth would rarely be of any consequence in healthy adults. Factors predisposing puppies and kittens to septicemic conditions include coexistence of inadequate nutrition and thermoregulation, viral infections, parasitism, and developmental and heritable defects of the immune system.

Aetiology

Bloodstream invasion is usually by the more common bacteria, such as Staphylococcus , Escherichia , Klebsiella , Enterobacter , Streptococcus , Enterococcus , Pseudomonas , Clostridium , Bacteroides , Fusobacterium , and Salmonella spp . Of these, gram-negative bacilli are seen most often. They may enter the bloodstream from the GI tract or from peritoneal, respiratory tract, skin and wound, or urinary tract infection.

Clinical Findings

The clinical manifestations of neonatal illness do not always allow specific identification of the cause. Furthermore, many puppies and kittens have unusual clinical presentations that may not be immediately associated with a specific illness. Death can occur so suddenly that noticeable signs are virtually absent. More typically, puppies and kittens cry often and show signs of restlessness, weakness, hypothermia, diarrhoea, altered respiration, hematuria, failure to thrive, and cyanosis; in advanced stages, they may slough parts of their extremities.

Diagnosis

Neonatal illness is usually diagnosed based on the case history and physical examination findings. Ideally, a CBC, plasma chemistry profile, urinalysis, urine and/or blood culture, and culture of suspected sources of infection is obtained. When dealing with neonatal sepsis, conducting a thorough search for the primary source of infection and collecting appropriate bacterial culture samples before initiating antimicrobial therapy is imperative.

The hemograms of septicemic puppies and kittens are usually characterized by a normochromic, normocytic anaemia. Thrombocytopenia and mild to moderate neutrophilia with a left shift may be present. Hypoglycemia is consistent with, but not specific for, neonatal sepsis. The remaining laboratory values from the plasma chemistry profile and urinalysis may reflect a specific organ failure.

Treatment

Early prompt care for the ill puppy or kitten is required. Because many neonatal diseases may cause sudden death, puppies and kittens suspected of having a severe illness should be treated immediately. In most instances, rewarming, fluid replacement, and antimicrobial therapy are started empirically. Severely ill puppies and kittens may also require glucose therapy (5% dextrose, IV or intraosseously) if hypoglycemia is present. Animals that are profoundly depressed or seizuring can be given 10-20% dextrose at 1-2 mL/kg.

Many newer antimicrobial agents have either an increased spectrum of activity or a diminished toxicity relative to previously available antimicrobial agents. However, specific pharmacokinetic data have not been obtained either in adults or in puppies and kittens, and therefore, the use of these antimicrobial agents remains somewhat empiric.

Drug distribution, especially in puppies and kittens <5 wk old, differs from that of adults because of differences in body composition, such as lower total body fat, higher percentage of total body water, lower concentrations of albumin, and a poorly developed blood-brain barrier. Because of these differences, a reduction of as much as 30-50% of the adult dose, or changes in dosing frequency, may be necessary when treating septicemic puppies and kittens.

Fluid replacement therapy and antimicrobial agents should be administered IV or intraosseously in severely ill puppies and kittens, as systemic absorption following PO, SC, or IM administration may not be reliable. Most drugs ingested by the lactating bitch or queen appear in her milk. The amount generally is 1-2% of the mother’s dose; therefore, severely ill puppies or kittens should never be treated by treating only the lactating mother. β-Lactam antimicrobial agents (eg, penicillins, cephalosporins, combined β-lactam/β-lactamase inhibitors) are the first choice for the treatment of septicemic puppies and kittens.

Malnutrition

Malnutrition develops when basic nutritional requirements for puppies or kittens are not being met and is especially common during the time when they depend entirely on the mother. Several factors can contribute to malnutrition in nursing puppies or kittens, including feeding replacement milk, death of the mother, maternal neglect, a larger litter than can be cared for properly, and partial or complete lactation failure by the mother due to mastitis, metritis, or underdeveloped mammae. In addition, puppies and kittens may be born underdeveloped, be so weak and sick that they cannot suckle, or have a congenital anomaly that precludes adequate milk intake. Failure to provide an adequate growth diet at 3-4 wk of age can also result in malnutrition.

Immediate recognition of a malnourished puppy or kitten is usually based on their smaller, lighter appearance, feeble attempts to feed, and/or inability to attain adequate weight gain for their age. High-pitched, constant crying or inactivity with an accompanying weak sucking reflex are advanced indications that the nursing puppy or kitten is malnourished. Reduced body tone and muscle strength may be evident on handling. Coexisting congenital anomalies that are not immediately life-threatening may be detected on physical examination as well.

Correction of malnutrition in nursing puppies or kittens generally requires that proper nourishment be provided. Complications that are frequently encountered during the management of malnutrition are diarrhoea, dehydration, hypoglycemia, and hypothermia. If diarrhoea develops during feeding of adequate amounts of commercial milk replacement formula, the amount of solids fed should be reduced to one half of that offered. This can be done by diluting the milk replacement formula 1:1 with water or preferably with a mixture of equal parts of Ringer’s solution and 5% dextrose/water solution. As the condition of faeces improves, the amount of solids can be gradually increased to the recommended level. Hypoglycemia and dehydration develop quickly when malnourished puppies or kittens are not adequately fed. Milk replacement formula should not be fed to a weak and severely chilled puppy or kitten that possesses a diminished sucking reflex or body temperature <35°C (95°F). Giving an equal mixture of warm Ringer’s solution and 5% dextrose/water solution parenterally or administering a warm nutrient-electrolyte solution PO every 15-30 min can help to alleviate or prevent dehydration and mild hypoglycemia.