Chapter 2 Nutrition of the Neonate

 

  2.1 Definition

• A. Neonatal malnutrition occurs when all the basic nutritional requirements for the neonate are not being met from birth to weaning. 
• B. The neonatal puppy and kitten are subjected to similar nutritional requirements, and survival of each depends on maternal behavior an the gradually increasing plane of nutrition provided. 

2.2 Causes

Immediately after parturition feeding should begin at regularly spaced periods and at gradually increasing rates of nutrient intake. Certain factors contribute to the development of malnutrition in the neonate. 

• A. Failure to nurse within 12-24 hours of partuition resulting in inadequate intake of colostrum for transfer of passive immunity. 
• B. Inadequate amounts of milk ingested due to the following
  •  1. Death of the bitch or queen
  •  2. Bitch or queen disowning one or more of the young
  •  3. Litter larger than can be cared for adequately
  •  4. Partial or complete lactation failure of the bitch or queen from pathologic conditions such as metritis, mastitis, or underdeveloped mammae
  •  5. Premature and underdeveloped puppies or kittens
  •  6. Weak or sick neonates that cannot suckle normally 
  • 7. Congenital defectes that preclude adequate intake, particularly defects involving the central nervous, digestive, cardiovascular, and respiratory systems
•  C. Failure to provide adequate supplemental feeding with solid food at 3-4 weeks after parturition

 2.3 Pathophysiology

• A. Every effort should be made to see that the young nurse after birth so that transfer of passive immunity available in the colostrum is as complete as possible.
  •  1. Some exchange (approximately 5%) of immunoglobulins does occur between maternal and fetal blood
  • 2. The young are covered to some extent by maternal antibodies until 2 weeks of age 
• B. Nutritional requirements are usually met by the nursing dam from birth to 3-4 weeks of age. 
  • 1. Constant crying or failure to attain steady weight gain and normal stools generally indicate that the amount or quality of the milk is inappropriate
  •  2. If these procedures do not increase milk production adequately, institute supplemental feeding 
• C. Start supplemental feeding in preparation for weaning at 3-4 weeks of age. 

2.4 Clinical signs

• A. High pitched, constant crying
• B. Weak attempts to suckle; milk not ingested
• C. Weight loss of more than 10%
• D. Decrease in body tone and muscle strength
• E. Coexistent congenital defect that is not immediately life- threatening 

2.5 Diagnosis

• A. There is a history of recent failure to suckle or gain weight.
• B. Typical clinical signs and physical findings allow immediate recognition of neonatal malnutrition. 

2.6 Treatment

• A. Successful hand-rearing of all or part of a malnourished litter of puppies or kittens requires the following.
  • 1. Suitable environment
  • 2. Correct quantities of a nutritious formula at the proper times
  • 3. Regular schedule of feeding, sleeping, exercise, and grooming
• B. Replacement feeding with a prototype of nutritive substance formulated to meet the optimum requirements of the young of the species is needed. (Mother's milk is the ideal food.) Various modifications of homemade and commercially prepared formulas simulating mother's milk have been used with success. 

  1. Homemade formulas for milk replacement 

  • a) Evaporated milk, reconstituted to contain 20% total solids and supplemented with 8.0 g of dicalcium phosphate per liter of formula
  • b) Fresh whole cow's milk 1 pint (473 ml)
    • Single cream (minimum of 18% fat) 6 fl oz (182g)
    • One egg yolk 15g
    • Cod liver oil 2-3 drops (0.3g)
    • Sterilized bonemeal 1 teaspoonful (4g)
    • Citric acid: 0.5 teaspoonful (2g)
  • c) Evaporated milk and sterile water 4:1 (v/v)
    • Dicalcium phosphate 5 g/L
    • Multiple infant vitamins 1 drop
  • d) Fresh whole cow's milk 8 fl oz (240 ml)
    • One egg yolk 15g
    • Multiple infant vitamins 1 drop
    • Corn oil 5 ml (4.75 g)
    • Cod liver oil 2-3 drops (0.3 g) 

  2. Commercially prepared formulas for milk replacement 

  • a) Esbilac, powder or SPF-lac, liquid (Borden) for puppies 

    b) Unilac, liquid and powder (Upjohn) for puppies 

    c) KMR, liquid (Borden) for kittens 

    d) Havolac Food Supplement, liquid in 13 fl oz cans (Haver Company) for puppies and kittens 

    e) Veta-Lac, powder (Vet-A-Mix) for puppies and kittens

  3. Supplemental feeding in preparation for weaning 

  • a) One part dry puppy food blended with three parts water 
  • b) Two parts canned puppy food blended with one part water 
  • c) One part dry kitten food blended with three parts water 
  • d) Two parts canned kitten food blended with one part water
• C. Feeding amount and frequency 
  • 1. These formulas generally provide 1.00-1.24 kcal of metabolizable energy per milliter of formula.
    •  a) Feed 1ml/7.5 g body weight during the first week, 1ml/6.0 g during the second week, 1ml/5.0g during the third week, and 1ml/4.5 g during the fourth week.
    •  b) This regimen provides a food intake of about 10-20% of body weight per day at birth and gradually increases to 20-25%.
  •  2. Underfeed slightly during the first several weeks of life to avoid digestive disturbances.
    •  a) Feed three or four times daily.
    •  b) After feeding, the abdomen is enlarged but not overdistended.
  •  3. Start with less than the prescribed amount of formula for the first several feedings and increase the amount gradually to the recommended feeding by the second to third day. Continue to increase the formula as weight gains and favorable responses to feeding are recorded.
•  D. Method of feeding 
  • 1. Keep all equipment scrupulously clean.
    • a) Do not prepare more formula than is required to feed for a 48-hour period.
    • b) Divide the formula into portions that are required for each feeding and store in the refrigerator (4 degrees Centigrade)
    • c) Before feeding, warm the formula to about 100 degrees Fahrenheit or near body temperature
  • 2. Nipple bottle feeding
    • a) Nipple bottles made especially for feeding orphan puppies or kittens are preferred.
    • b) When feeding, hold the bottle so that the neonate does not ingest air.
    • c) Enlarge the hole in the nipple so that when the bottle is inverted milk slowly oozes from the nipple.
    • d) When feeding, squeeze a drop of milk onto the tip of the nipple and then insert it into the neonate's mouth.
    • e) Never squeeze milk out of the bottle while the nipple is in the mouth; doing so may result in aspiration pneumonia and death 
  • 3. Tube feeding
    • a) Tube feeding is the easiest, cleanest, fastest, safest, and most preferred way to feed neonates. 
    • b) Fill a syringe with formula, fit with an 8 gauge French, 12 inch human infant rubber feeding tube and deliver appropriate quantities of milk directly into the stomach.
    •  c) Mark the tube clearly to indicate the depth of insertion so as to ensure gastric delivery; i.e., once weekly measure the tube from the last rib to the tip of the nose.
    • d) When feeding, slowly inject the correct quantity of formula over a 2 minute period to allow for slow gastric dilation.
    • e) Regurgitation rarely occurs, but if it does, withdraw the tube and interrupt feeding until the next scheduled meal.
    • f) For the first 3 weeks of like, after each feeding burp the neonate and swab the genital area with moistened cotton to stimulate defecation and micturition.
  • 4. Supplemental feeding
    • a) To encourage consumption of solid food by the neonate, mix enough water with the solid food to make a thick, mushy gruel.
    • b) Smear some of the gruel on the neonates lips, being careful not to get any in the nose.
    • c) In licking the gruel off their lips, they generally start eating the solid food and progress rapidly to eating from a bowl.
    • d) Once they are eating from a bowl, gradually decrease the amount of water mixed with the food until only the solid food is fed three times a day. 

2.7 Patient monitoring

• A. Major complications encountered during treatment of neonatal malnutrition are the following.
  • 1. Diarrhea
  • 2. Dehydration
  • 3. Hypoglycemia
  • 4. Hypothermia: rectal temperature below 94 degrees Fahrenheit (34.5 degrees Centigrade)
• B. If diarrhea develops during the feeding of homemade or commercially prepared formulas, immediately reduce a solid intake to one-half that offered.
  • 1. Dilution of 1:1 with water or preferably with a mixture of equal parts of lactated Ringer's solution and 5% D/W works well. 
  • 2. As the condition of feces improves, gradually increase solids to the recommended level again.
• C. Hypoglycemia and dehydration occur quickly when the neonate is not eating.
  • 1. Do not attempt to feed formula to weak and severely chilled neonates
  • 2. Give an equal mixture of lactated Ringer's solution and 5% D/W at 3.5-4.0 ml/100g SQ.
  • 3. Correct body temperature gradually (over 1-3 hours) in an environment of 85-90 degrees Fahrenheit.
  • 4. Then administer 10% glucose solution PO at 30 minute intervals until rectal temperature is greater than or equal to 90 degrees Fahrenheit
  • 5. Formula may be substituted for the 10% glucose solution at this time.
  • 6. Feed slightly below recommended levels until satisfactory progress is recorded