Page 1059 - Small Animal Internal Medicine, 6th Edition

CHAPTER 57 Neonatology and Pediatrics 1031

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A B

FIG 57.33
(A) Intracranial ultrasound using a trans (open) fontanelle approach. (B) Resultant
ultrasound image showing an increased amount of cerebrospinal fluid present in the
ventricles.

neonatal resuscitation earlier) (Grundy et al., 2009). The Treatment includes gentle manual separation of the lids and
normal neurologic examination of the pediatric canine has topical triple antibiotic ointment (erythromycin in kittens).
been reported (Lavely, 2006). Weak or ataxic ambulation Microphthalmos, enophthalmos, strabismus, distichiasis,
can indicate a neurologic or musculoskeletal abnormal- and entropion become apparent after the eyelids separate.
ity. Morphologic neurologic abnormalities occur most fre- Temporary eyelid tacking (puppy <4 months of age) with
quently. Hydrocephalus has an increased frequency in toy 2 to 4 vertical mattress sutures can preclude or postpone
and brachycephalic breeds, and can occur in cats. A domed surgical correction of entropion. Congenital cataracts can
calvarium, open fontanelle, and prominent suture lines are be genetic, secondary to in utero conditions (drugs, toxins,
often present. Aqueduct atresia, birth trauma, or meningo- nutritional), and amino acid deficiencies in artificial milk
encephalitis can cause the development of hydrocephalus. products. Epiphora can be secondary to increased lacrima-
Clinical signs vary from inapparent to progressively debili- tion from ocular irritation or imperforate or stenotic naso-
tating. Ultrasound, possible through the open fontanelle lacrimal puncta. Medial canthal trichiasis causes wicking of
typical of brachycephalics, can confirm the presence of exces- tears onto the facial folds; this is also recognized with shallow
sive cerebrospinal fluid within the ventricles (Fig. 57.33, A, lacrimal space seen in brachycephalic breeds. Keratocon-
57.33, B). Cranial and spinal dysraphism occur secondary to junctivitis sicca can be congenital in some breeds (York-
embryologic defects in neural tube closure. The presence of shire Terrier) or secondary to canine distemper virus and
resultant neurologic defects generally warrants euthanasia. herpesvirus in kittens. Prolapse of the third eyelid gland
Vertebral anomalies include hemivertebrae, fused vertebrae, occurs in brachycephalic dogs and the Burmese cat; preser-
and butterfly vertebrae, and are usually subclinical unless vation of tear production is accomplished by anchoring the
spinal cord compression occurs. Cerebellar hypoplasia and gland in place rather than excising it. Congenital disorders
abiotrophy cause truncal ataxia, hypermetria, and intention of metabolism can result in corneal opacities.
tremor at the onset of ambulation. Abiotrophy is progres-
sively debilitating and may occur with lissencephaly. Dysmy- Dermatologic Disorders
elination and hypomyelination of the central nervous system Juvenile cellulitis is a progressive granulomatous pustular
cause tremors with onset by 1 to 2 weeks of age. disorder of puppies. Immunosuppression is indicated for
resolution and prevention of severe cicatricial lesions. It is
Ophthalmologic Disorders most common in dogs younger than 4 months of age but is
Ocular anomalies account for 15% of all congenital defects occasionally reported in dogs up to 4 years old. The eyelids,
in puppies and 9% in kittens. Eyelid agenesis occurs most pinnae, lips, chin, muzzle, paws, abdomen, thorax, vulva,
commonly in kittens and is apparent at birth. Neonatal prepuce, and anus can be affected with lesions that fistulate,
ophthalmia becomes apparent before the eyelids separate drain, and crust (Fig. 57.34, A, 57.34, B). Lymphadenomeg-
at 10 to 14 days of life (see Fig. 57.19). Bacterial infection is aly, most commonly mandibular and superficial cervical, can
most likely in puppies, viral (Herpes, chlamydia) in kittens. be distant from the affected skin sites and is often painful