Page 1036 - Small Animal Internal Medicine, 6th Edition

1008 PART VIII Reproductive System Disorders

BOX 57.1 BOX 57.2
VetBooks.ir Neonatal Resuscitation Equipment Kit Neonatal Resuscitation Protocol

• Syringes (tb)
• Drugs (epinephrine 0.1 mg/mL +/− 0.01 mg/mL, A, B, Cs—Airway, Breathing & Circulation
2.5%-5% Dextrose, Ceftiofur*) A. Clear airway of amniotic membrane and fluid by
• Oxygen sources suction. Do not swing. Place with head below thorax
• Suction (pediatric bulb syringes, DeLee mucous traps) to improve drainage.
• Small face masks B. Gentle brisk towel drying to stimulate respiration. If
• Towels (small) not breathing, start positive pressure ventilation using
• Heat sources (Baer, warm water blanket, infrared snug face mask and 21% O 2 .
lamp, hair dryer, warm water bottles) C. Circulation: If HR is slow, improve ventilation/
• Puppy box (Styrofoam) with heat support oxygenation.
• Multiple clean mosquito forceps & small scissors Is Resuscitation Effective?
• 3-0 monofilament suture for umbilical cord ligation
• Tincture of iodine 2% 1. Is the puppy vocalizing?
• Bowls for warm water baths 2. Is the mucous membrane color improving?
• Pediatric/neonatal stethoscope 3. Is the puppy moving?
• Doppler Keep in mind that even a nonviable puppy can have
• Neonatal gram scale red color in the mucous membranes from the maternal
circulation and fetal hemoglobin.
*Naxcel®/Ceftiofur Protocol Rxs if ABCs Fail
Reconstitute with 20 mL bacteriostatic or sterile water to 50 mg/mL
solution • Epinephrine (1:10,000 or 0.1 mg/mL); give
Stable for 12 hours at room temperature (once reconstituted) 0.0002 mg/g (e.g. 500 g neonate would receive
Stable for 7 days if refrigerated (once reconstituted) 0.1 mg (0.1 mL) IV, IO, IC. Smaller neonates could
Stable for 8 weeks if frozen (once reconstituted) require further dilution of epinephrine to 0.01 mg/mL
Freeze remainder in 1-mL increments in labeled RTT • Atropine not advised
Neonatal dose is 2.5 mg/kg (0.0025 mg/gram) SC bid for 3-5 • Doxapram not advised
days • Acupressure if poor respiration: 27 ga or acupuncture
needle into the nasal philtrum, insert and turn
Prolonged Problematic Case
Hypothermic? Warm water bath at 95-98° F
Hypoglycemic? Rx Dextrose 2.5%-5.0% Dextrose IV, IO
Reasons to Stop
1. No pulse after 10 minutes (check with Doppler or
pediatric stethoscope)
2. Agonal breathing for more than 20 minutes
3. Severe congenital defect

Tube feeding should be delayed until the neonate is euther-
mic; hypothermia induces ileus, and regurgitation and aspi-
ration can result. Thermal support should continue through
FIG 57.1 4 weeks of life (Fig. 57.8, Box 57.3).
Removal of amniotic membranes from the muzzle of a Neonates lack glucose reserves and have minimal capac-
neonate. ity for gluconeogenesis. Providing energy during prolonged
resuscitation efforts becomes critical. Clinical hypoglycemia
their dam. Neonatal dogs and cats lack thermoregulatory involves blood glucose levels less than 30 to 40 mg/dL and
mechanisms until 4 weeks of age, so the ambient tempera- is best treated with IV or IO dextrose at a dose of 0.1 to
ture must be high enough to facilitate maintenance of a body 0.2 mL of a 2.5% to 5.0% (25-50 mg/mL) dextrose solution.
temperature of at least 97° F (36° C). Hypothermia negatively Single administration of parenteral glucose is adequate if the
impacts immunity, nursing, and digestion. Postresuscitation, puppy can then be fed or if it nurses. Because of the poten-
exogenous heat should be supplied, best in the form of an tial for phlebitis if administered intravenously, 50% dextrose
overhead heat lamp. Heating pads run the risk of burning solution should only be applied to mucous membranes;
neonates incapable of moving away from excessively hot sur- however, circulation must be adequate for absorption from
faces. Chilled older neonates must be rewarmed slowly (30 the mucosa. Neonates repeatedly administered dextrose
minutes) to avoid peripheral vasodilation and dehydration. should be monitored for hyperglycemia because of immature