How Do You Check a Dog’s Progesterone Level?
We’re going to talk very briefly about progesterone testing, that knowing the date of ovulation is absolutely critical, particularly if you have either a high risk pregnancy, which of course, you don’t know until you’re in the middle of a high risk pregnancy. And if you’re scheduling C-sections, it’s very important because that way your veterinary team can know the date and have a C-section.
These are the high risk pregnancies that we want to be able to help you manage. By knowing when the female has ovulated, we can know when her C-section is due. Then we also use progesterone at term. Some people call it reverse progesterone, but that isn’t always helpful for the dog that went into labor early. That’s important for us to know, but it’s not entirely the number that we’re going to look at. I want to know when she ovulated before I schedule a C-section. So, really spend the time and the money working with your veterinary clinic to figure out the date of ovulation. Whelping, of course, is one piece of it, scheduled C-sections or another. Scheduled C-sections can be 61 to 62 days post ovulation safely, with the puppies being mature enough to be born.
And then, of course, we have the emergency C-section. So those are the things that we do in our real life. pregnancy is 63 days long from ovulation, plus or minus 48 hours. You may have a go a little early, if it’s a brachycephalic breed, if it’s a Cavalier King Charles spaniel or if it’s a female pregnant with a lot of puppies, typically they should go 63 days. If they have one or two before they might go 65. After day, 65 puppies need to come out. So it’s really important that we know because we only have 48 hours, two days ahead of time to two days behind, time to accurately get these puppies out where they will be able to survive. Too a short of time they don’t have surfactant. They don’t breathe. Too long a time, the placenta starts to break down and fall apart, which it’s supposed to so that it’s born with the puppy. But if we don’t have good timing, we’re not going to hit the mark on the best outcome for our puppy survival, We should never see a pregnancy shorter than 61 days from ovulation.
A Successful Dog Pregnancy
Neonatal success is dependent on the female dog and her age, her nutrition, the quality of her pregnancy, the quality of her whelping, which is parturition, the quality of her colostrum and the nutrition that we provide to the puppies. So it’s very important that we have all these pieces working together.
Where do we lose puppies? We can lose them any way from conception all the way through the early pediatric period. After we get through the first two weeks, typically we don’t lose puppies, but the stillborn puppies, the neonatal mortality from stillborn, the ones that don’t survive well in the first 24 hours, those are really high numbers.
We want to do our best to keep that from happening. The most important thing is the transition of the puppy from total dependance to total independence. And so my question to you are shouldn’t all your puppies be born alive? And in reality, if you’ve always had every single puppy born alive, you’ve been a very fortunate breeder because most of us somewhere along the way have only lost one puppy and maybe an entire litter.
Why do we lose puppies? Well, there’s a lot of reasons, and we’ll talk about those. What do we take for granted? Because those of us who have been successful and never lose a puppy assume that that should happen. Why isn’t this easy? Like, why is it so much work? What can go wrong? Oh, a multitude of things. If it can go wrong, it will.
What can we do to improve this? There are reports of somewhere between 10% and 40% of losses from conception to weaning. That’s a pretty large number. There are catastrophic events where we lose an entire litter. Sometimes a female, typically less than 10% would be ideal. And typically we will see somewhere around 6 to 11% of our puppies lost at C-section.
Why is this important? Because you work really hard as dog breeders. You know those people who think you just have it really easy that you just rake in the money and go to the bank. You work really hard to get your puppies out alive. You work hard to have your breeding stock selected and screened for good health. You work hard at raising the dam and the sire. You work hard at selecting the sire if it’s a dog that you don’t own. You work really hard to get the timing of the breeding right and manage the pregnancy correctly, to get the whelping to work correctly or their C section. You work really hard at this, so it is not what you can take for granted.
What Can Cause a Newborn Puppy to Die?
The causes of loss can be maternal in origin. It can be dystocia, which is difficult labor, meaning she had a hard time pushing the puppy out quickly enough, so the puppy lost its blood flow, didn’t get enough oxygen, the stillborn puppy. Or she may have had the puppy, but then she’s not a good mom. She laid on him. She didn’t lay down to take care of him. Something went wrong during that maternal period. Sometimes she doesn’t have enough colostrum or enough milk and it may be genetic. It may not be her fault. It may be that she had puppies prematurely. It may be we’re not feeding her correctly. There’s a lot of things that we need to know about this. And like I said, every now and then we have preterm labor, so those are maternal causes.
Next, we have the fetal causes, which will include a variety of different things, including congenital abnormalities or something that they’re born with, genetic defects, which are not the same as congenital. Congenital means you’re born with it. Genetic is something that you have genetically that you inherited. You can have a genetic defect that doesn’t show up until they’re much older. You can have a congenital abnormality. That means they’re born with it but didn’t inherit it. There can be infectious diseases. There can be parasites. We can have parvo. we can have intestinal parasites. We can have injuries. Sometimes the puppy gets too close to a heat source. Sometimes the puppy’s mother steps on it. We can have environmental exposure. They got too cold. They got chilled. Something wasn’t right about the environment. Sometimes they’re not strong puppies and they failed to nurse. They may not nurse because they’re not skilled at it. And it may be that there’s too many puppies and they get knocked around and pushed off the nipples. So a lot of things can go wrong.
And then we can also have human error where, for instance, we didn’t get the female in for her progesterone testing. We didn’t get her in early enough for a C-section. We didn’t identify that at the time she went into labor, she was in trouble. If you go to the veterinary clinic and they didn’t use appropriate anesthesia or IV fluids at the C-section, that can could contribute to human causes of fetal loss. I like normal saline for subQ fluids, not lactated Ringers. Normal saline is going to be better for the puppy at a very early age because they cannot metabolize lactate.
We can have staff that are inexperienced at neonatal resuscitation or you might be inexperienced. So we’re going to talk about that today day. And sometimes it’s just bad luck. You’ve done everything right. You’ve worked really hard to do everything. You know, the neighbor’s dog got breed, the beagle. And then she had her puppies under the porch in a snowstorm and they all survived. Yeah, sometimes it feels like no matter how hard you try, you’re not the person that’s as successful as that missed breeding.
How Do I Know if My Newborn Puppy is Breathing Properly?
The first breath a puppy takes is the transition from total dependance where they’re kept warm, they have oxygen through the bloodstream, they have nutrition through the bloodstream. They’re in a nice environment. They’re totally dependent on their mother, to the total independence where they go from that to poof, they’re out into the real world. And in seconds, they have to go through this big transition.
At birth, there’s a change in the blood flow and a change in the lung function immediately as the puppy comes out. You have to clear the fluids out of the lungs because they are filled with fluid at the time that the puppy is born. There’s surfactant that should be in the lungs to help the puppies’ lungs inflate the alveoli in the lungs. There needs to be a consistent respiratory effort. That puppy needs to be breathing frequently with the right coordination. The puppy needs to develop its own methods of energy metabolism. It needs to start taking into energy and taking care of itself, nutritionally. It needs to control its body temperature. A lot of things that all have to happen, boom, in one instant, exactly at the right time for things go well for this puppy and it has a chance to survive. And I would challenge you to say that breathing is the single most critical and complex adaptation that ever happens in your life. You go from not having to circulate blood through your lungs to picking up oxygen. Of course, there’s blood flow to the lungs for the necessary tissue support, but there’s no lung oxygen exchange at the beginning. The fluid has to clear. You have to get the blood vessel that called the ductus arteriosus, which is the part of the vasculature in the chest that takes the heart circulating blood and pumped it only through the lungs for blood flow, but not for oxygen exchange. That has to change. All these things instantly have to take place. And when I talk to Ken Sunden from Puppywarmer®, he said, “You know, I never really thought about it that way before.” So, I want you to start thinking about what happens.
When a puppy is coming down the birth canal or being born at C-section, we have this puppy that’s been in the fluids underwater and it didn’t need to breathe. Okay, now you’ve popped out. Your head’s out of the vagina. Maybe if you’re coming with, like, 40% of the puppies with a rear end, first in the head, second , that puppy’s already had the stimulation of the umbilical cord tearing, the blood flow changing, the oxygen levels started to drop. This puppy’s stimulated to breathe while it’s still inside the birth canal. How does that get timed to be just exactly right? So what initiates that breath? Lots of changes that have to happen at the right time. Their oxygen level drops as their placenta separates. The carbon dioxide levels start to go up as the placenta separates. As the umbilical cord tears loose, it changes the blood pressure in the umbilical cord and from the placenta. So it stimulates the breathing. The ribs have to be flexible, the diaphragm has to move. You have to time this perfectly and we have to get the fluid cleared out of the lungs so that oxygen exchange can start to take place. So what happens? I want you to not assume that this should just be taken for granted. It blows my mind every time a puppy is born vaginally, born by C-section, for me to see this miracle of the first breath happening. I don’t take this for granted, and I don’t want you to. If the puppy breathes too early, they inhale the fetal fluids and they don’t end up being able to exchange oxygen in the lungs because it’s like they breathe in a swimming pool. If it’s too late, they don’t have blood flow to their brain. They’ve had brain damage. If they breathe in meconium, the first fetal stool, they probably are going to end up with pneumonia. So if they were distressed during the birth process, then the fetal fluids have meconium in them, that yellow brown stuff. And if the puppy breathes that in, they can go home and get pneumonia. So it’s very important that we’re paying attention to these things.
I want you to think about the lungs like a bunch of grapes. So the main stem bronchi and the trachea are the largest stems that come down from the oral cavity, from the mouth down into the chest. And then it divides into mainstream bronchi and then into smaller bits, which are called bronchioles and then into alveoli, which are the little tiny air sacs, microscopic air sacs down inside the lungs where the actual oxygen exchange takes place, where the oxygen comes in from the breathing and it exchanges across the membrane and oxygen is picked up by the red blood cells and goes into the circulation.
It’s a very complicated and very complex event. Remember, your biology class or your zoology class where you learned about these things. The airway has to be open for this to happen so that the oral cavity has to open and the nostrils have to be clear. They have to have the fluid out of the lungs. The surfactant then has to be there, that is the protein down in the alveoli of the lungs that allow those little alveoli, those little air sacs to open up and allow the oxygen exchange to go from the airway into the red blood cells and hit the circulation.
It’s similar to blowing up a balloon. What happens with your first and second and third breath? The first time you bubble blow up a balloon, it can be really hard because it hasn’t been blown up before. But each time the lungs inflate, it gets easier and easier and easier, just like blowing up a balloon multiple times. If you tied a knot in it, you can blow it up and let the air out. Blow it up again, blow it up again, and it gets easier every time. The diaphragm has to move, the ribs have to move and the fluid has to get out of the chest. So think about that. If you’re hesitant to understand this, then grab yourself a balloon that’s not been blown up and do a little practicing.
How does surfactant get into the lungs at the right time? Well, until the fetus is mature, they don’t have surfactant in their lungs. That’s why it’s so important that we have that very narrow window of time, that 48 hours prior to day 61, day 62 after ovulation, where it is okay, because the surfactant has developed in the lungs. So the fetus has to be mature. Surfactant does develop a little bit earlier if there is stress for the fetus. If the female hasn’t been well, if there’s 15 puppies in the uterus and they’ve been crowded, they’re a little bit stressed. That raises their cortisol levels and they’ll start to stress a little bit and develop surfactant a little bit earlier.
And if we’re scheduling C-sections and need to have that surfactant, Solu-Medrol can make a big difference in the puppies. If you give that to the female, not to the puppies, the Solu-Medrol is a steroid that allows the puppies to start developing surfactant just a wee bit earlier. So sometimes that extra 24 to 48 hours is the difference between survival and not having survival.
The 4 Hs
I want you to think about these four Hs. There’s hypoxia, which is oxygenation. There’s hypothermia, which is the temperature or the heat. The third stage is dehydration, so we’re going to seek a little bit of an H in there. And then the fourth is hypoglycemia or food and glucose.
I want you to think about the four Hs like a box. If you see one side of the box collapsed, you can see the other sides collapse as well. What does that have to do with hypoxia, hypothermia, dehydration and hypoglycemia? It means that if one of those four things starts to fail, everything else cascades and it fails too. So we have to have a nice, strong, intact four parameter box for our puppies to do well. Hypoxia would always have to come first. Breathing, hypothermia, hydration and hypoglycemia. What are the things that we can measure? Those are going to be the APGAR score and oxygenation, the body temperature with the thermometer, hydration is based on the appearance of the urine. Urine color is how we assess that. And then weight and blood sugar, which is hypoglycemia. We’re going to take these one at a time.
The first thing I want you to be able to do is identify your high risk puppies using APGAR scores, birth weight, litter size and four Hs. And of course, breathing always comes first with appropriate interventions.
APGAR Scores for Puppies
APGAR scores were developed in the 1950s when Virginia Apgar, who was the first woman anesthesiologist, to be boarded an anesthesiologist in the 1950s as a physician. She named the Apgar score after herself. Even after she’s passed away, we are still talking about Virginia Apgar and her skill set.
Obviously they don’t hang babies upside down anymore. We don’t swing puppies anymore. So the APGAR score stands for five things. It stands for mucous membrane color or appearance. Second is pulse, the heart rate. Third is grimace. Now babies grimace. They make pretty little faces. Puppies don’t, so we use irritability reflex or the fact that they’re actually reflexively responding to our touch. Fourth is the activity or the mobility. And fifth is respiration. So a puppy can get anything from a zero on all of those, which means that it’s going to have a zero score all the way down. If the color is bad, it’s not got a heartbeat, it’s not moving, it doesn’t breathe. Those are all zeros. That puppy’s got a pretty tough go to try and survive, but with some support every now and then we can save one.
But it’s when we get up into the fours in the sevens that we really need to pay attention. If a puppy comes out screaming, pink, good heart rate moving, like in a C-section, like you have to chase it across the towel to keep it from disappearing off of the edge of the table. Those are the puppies that get tens.
And my staff does APGAR scores on every puppy. And they will, as I hand them out of the uterus at C-section, if the puppy’s, like I said, squalling, screaming, running like the greyhound running out of the uterus, and they have to catch the little creature, they’ll say to me as they catch the puppy, “It’s a ten!” So we know our APGAR scores are really important.
So these were converted into something we can use on the veterinary side by Peggy Root-Kutritz, who we owe a great debt of gratitude to. She is a theriogenologist on staff at the University of Minnesota in Saint Paul. She converted this into something we could use on the human side. So very important that we understand that the APGAR score measures viability, the risk factors that we need to monitor and the support that we need for our babies.
We know from the Neocare information that APGAR score puppies with less than a seven have a 22-fold increased risk of death in the first 8 hours, and that if we have a four to a seven but we give them good support, good interventions that we can get up to 90% of these puppies to survive.
How do we resuscitate? We want, of course, to do good suctioning. We want to make sure that they get oxygen so that’s where your puppy warmer/oxygen concentrator can come in handy. Your veterinary clinic, if your puppy is being born there, may give epinephrine to the puppy if the heart rate is inadequate. Caffeine. I have a lot of people that use that. And then, of course, breathing, helping them breathe and veterinary care as indicated are all important and we know puppies with a 0 to 3 need intensive neonatal resuscitation.
How do we measure oxygen? Well, we don’t have a good way to do that at home at this time. Right now that’s the little clip that they put on your index finger when you go to the emergency room or the doctor and they want to check your oxygenation. The ones we have on the veterinary side work really well, but the hundred dollar ones that you can buy on eBay and Amazon for people, I have not yet found a $100 item that works on a puppy. Just because we measure it doesn’t mean we can manage it. It only helps you to manage it if you know what you’re measuring.
Removing Mucus Membranes from a Newborn Puppy
So the first thing is breathing. We need to get the membranes off. I just use a gauze or a towel. I don’t use scissors because I’m always worried I’m going to hurt the puppy. Now, as they come through the birth canal, they get a good squeeze. If they’re being born by C-section, they don’t benefit from that squeeze, so we need to use our Delee mucus trap, our bulb syringe, and then some other techniques.
Despite the name Delee mucus trap, I think the Delee mucus trap does a better job on the thin watery fluid and the bulb syringe does a better job on the thick mucusy fluid that puppies will have in their airway. And it often takes both. I alternate back and forth. If I hear gurgling, I use a bulb syringe, I’ll use the Delee and I go back and forth so you can get deeper into the airway with the Delee mucus trap than you can the bulb syringe and you get a different character of fluid out. So I would not pick one over the other. I would have both of those on hand.
There are some techniques with the airway and the mucus trap. There’s also an accordion technique where you want to put the puppy’s head down and fold it so its chin touches back to where it’s belly is, not over the back, but down toward its tummy, where you can stretch the puppy out and then flex it a few times. And oftentimes that will help clear fluid. But the Delee mucus trap is really my favorite tool. They’re not difficult to use. They’re very affordable. It’s great tool. I would never whelp a litter without one of these. So if you’re unsuccessful in raising your puppies, you really need to get a Delee. I would suggest you buy two, one for you and one for your vet clinic. They’re a very simple device. They come in a sterile package. We use them because we’re on the veterinary side. All you need to do is put one end in your mouth, the other end in the puppy’s mouth, gently move it around and you will pick up fluid. It’s just like using McDonald’s straw. You can tell when you’re in the fluid.
Next is the bulb syringe. We’ll use that as well as the Delee to clear the mucus. After they’ve got him breathing we put him in an oxygen tank and of course, Puppywarmer® has an Oxygen Concentrator. It’s a great device. It can take room air, which is 20% oxygen and turn it into 95% oxygen. As long as you have electricity, you can make oxygen for your puppies and not have to worry about your welding tank running out at 2:00 in the morning. If they’re still not breathing, we use a 25 gauge needle in this location. It’s called Acupuncture Point gv26. Some people will put it in and peck with it. Some people put it in and turn it. You just barely put it in. Then you can very easily use that as your stimulation point for puppies to start breathing. Make sure you have some of those small gauge needles on hand when you’re doing your whelping. I use a 25 gauge. If you only have a 22 gauge for your vaccinations, better to grab one than not to have it.
Next, if our puppies are breathing, I stop. I don’t do a needle. I don’t do these other things. But if they’re not breathing well, we use the 5 Hour Energy as a caffeine source. It’s not the beverage, not the big can. It’s just a little tiny bottle that you can buy at the checkout, at the gas station or the truck stop. All it takes is a drop or two on the tongue of a puppy. If it’s not breathing adequately, the caffeine will stimulate it and that can be repeated. And next, if your vet has dispensed Dopram to you, Dopram is a respiratory stimulant. The concern is that it’s a controversial topic. If you use Dopram, every puppy, you’re going to run into trouble. It is only meant for puppies that are really struggling that after 10 minutes of being born, they’re still not breathing. After your airway is cleared, you can go ahead and give a dose of that if you have a prescription for it. It is a prescription item, but it should be used as your last resort. The reason for that is that it increases the metabolic requirements of oxygen in the brain. If you’re giving it at the same time oxygen is not being delivered by breathing, then you can actually make the situation worse. So you don’t want to use this until the puppy’s 10 minutes old, that you’ve done all your other resuscitative techniques and it’s not working. That is my last resort. Do I think I’ve got dogs in the world that would have passed away if I hadn’t done it? Absolutely. Do I use it on every puppy? Absolutely not. So be careful with it.
Now if you’ve got them breathing, but there’s still a lot of fluid coming out, you can tilt them head down. You want to tip them, head down, not swing them, but tip them head down, so fluid continues to drain. This kind of makes the puppies mad, so they’re more likely to breathe because they’re a little bit ticked off at you. And like I’ve said a couple of times, don’t swing puppies. We used to back in the day when I graduated from veterinary school. It was okay to swing a puppy, but it causes brain damage and bleeds in the brain. So please don’t do that. If you’re at the veterinary clinic, you can have your technicians learn how to do intubation. If you work with a vet tech or a veterinarian that’s interested in learning this technique, I’m more than happy to help them.
If you see a curled pink tongue, please continue to work on the puppy, even if you don’t have a stethoscope. This puppy has a chance. You see the curled of the tongue. If it’s flat and gray, you’re probably not going to get that puppy to survive. If there’s a curl to the edges and it’s pink, keep going. These are the tools we use to intubate puppies.
Have a stethoscope. These are items so you can check for breathing and for heartbeats. The most important parameter you should measure at first is the APGAR score. But please don’t overlook that. It’s easy to do.
At our practice, all of our puppies born by C-section are born into a colored towel with an associated stopwatch so my staff can time their time of birth and know if it’s time to give the Dopram, if it’s necessary, or not. And then they are marked with a specific color of nail polish that allows them to go home with you as the breeder identified for where they were in the uterus and what their APGAR score was and what you need to do to help support them if they had a low APGAR score. So instead of going home and trying to figure out if it’s the one with the brown spot on its left or the right ear, you can very easily identify that puppy. We also have the Breeders Edge® ID Me Collars that can help you identify those. And this is what my surgery report looks like. Again, if you have a vet clinic or a vet tech that’s interested in working with this, I can help them get this figured out. So this Y is where we’ve sort of geographically given an identification for where the puppy was in the uterus. Then we know what the birth order was, what color the puppy’s towel was, who the staff member was, and what time that puppy was born.
How to Keep a Newborn Puppy Warm
Hypothermia comes next. It’s essential we keep our newborn puppies warm during resuscitation. You can take their temperature with a rectal thermometer. Puppies do have a big enough rectum, even if they’re little tiny puppies, with some lubrication on the thermometer. You can get these quick read digital thermometers that you can very easily monitor their temperature. And again, we get back to this hypoxia and hypothermia. If they’re cold, then their gut stops moving. That’s called ileus. They start to foam up their food in their stomachs. They start to aspirate that, and then they become septic. Their glucose level drops, they dehydrate and everything goes wrong. Room temperature, where the puppy is should only be about 75 degrees. You don’t have to make it 90 degrees in the room. But the surface for the puppies are kept should be 90 to 95 in their first 24 hours with a rectal temperature of 94 at the beginning, in the first 24 hours. By the second day, they should be up to 96 degrees and then the temperature goes up about one degree a week as they mature. A hypothermic puppy has a fourfold increased risk of death.
So how do we keep them warm during our C-sections? I use a fancy gift wrap tray that we put heating pads in. I put them in a tray because many times my clients are busy taking pictures and putting them on Facebook instead of paying attention to where their puppies are. So I want to go through a few things here from Puppywarmer from Ken Sunden, and he’s got some words of wisdom here:
- We want to create conditions that encourage neonatal help
- Prevent mistakes that you can make that unnecessarily cause at-risk puppies
- Be in tune with the puppies to intervene quickly if there’s an early problem, you can intervene
- Keep them warm and dry, feed them. Keep them warm and dry, feed them. Keep them warm and dry, feed them. Just keep doing those again and again and we’re going to go into a lot more detail.
The Puppywarmer system is two pieces of equipment. It’s the oxygen concentrator which makes 95% oxygen out of room air and the puppy warmer incubator. Together I’ve had clients call me and say, Oh my gosh, Dr. Greer, the puppies go into the incubator with oxygen and they zoom around like puppies on a racetrack. It’s amazing how well they do. I also use the heated whelping nest, to keep puppies warm.
How Do I Know If a Newborn Puppy is Cold?
If you look at your puppies, you get a pretty good idea of how they look. If they’re curled up there, if they’re all on top of each other, they may be cold. If they’re stretched out and warm, especially if they’re lying on their back, these are puppies that are warm and comfortable. But remember that puppies don’t want to all be at the same temperature all the time. They like a thermal gradient, meaning that they can move around the warmer and cooler areas in the whelping box as it suits them.
So Ken has deliberately designed the incubator to not always be exactly at the same temperature in every corner that they can adjust their temperature by a few degrees. Heat lamps are a big No No in my world. We almost set our barn on fire one year. A client set their garage on fire. So I’m very concerned about fire. I’m very concerned about the female being overheated or the puppies being overheated and dehydrated. If we give them a thermal gradient where the heat source is from underneath, it’s a much safer source.
How Do I Know if Newborn Puppies are Dehydrated?
Third is hydration. If we have dehydrated puppies, you can’t tell by the back of the neck, the skin. That is going to work in a puppy because they don’t have the body fat of an adult dog. So you need to look at the color of the urine with this very fancy device called a cotton ball. The color of the urine on a cotton bar should be very pale yellow. If it’s a darker yellow, the puppy is dehydrated and needs to either nurse more or be supplementally fed.
Do I Need to Put Iodine on a Puppy Umbilical Cord?
It’s really important that we do our umbilical cord care on these puppies. I recommend Breeder’s Edge Clean Cut® Iodine. It’s a gelatinous kind of Betadine so that the puppy has a nice dip of iodine around the cord. This is tincture of iodine, which is iodine and alcohol, which dries up the cord. I don’t want you to kind of mist it on. I want you to actually dip the cord in this. And this is a bottle that’s meant to be a one use product, so don’t reuse it. It’s a little bit more than you probably need. But 30 mils is about as small as we can make a device that really works. So dip the cord. It doesn’t stain. It does a great job.
Some people ask me, does the umbilical cord heals slower when cut with surgical scissors as opposed to mom chewing it? No, it’s really dipping in the cord in the tincture of iodine that’s going to change that. And the faster it dries up and falls off, the less likely they are to get an infection up into the belly. I lost one of my own puppies to that when I was dipping chlorhexidine, which was the current recommendation. So I use tincture of iodine.
Hypoglycemia in Newborn Puppies
Fourth is hypoglycemia, the blood glucose. I don’t routinely check glucose levels on normal puppies that are gaining weight, thriving, have good color, are moving around. But if you have a puppy that’s sick, you certainly can do a blood glucose level on them by sticking their footpad. If you have a glucometer because you have a diabetic member of your family, you can use that with the same dipstick that you used for people. But there is a device called a pet test that is meant for measuring glucose levels in our puppies. The glucose level in the blood should be at least 90 milligrams per deciliter. If they’re hypoglycemic, they have a fourfold increased risk of neonatal death, according to Neocare.
And then fourth is our food and fluids. I do keep track of the weight, the temperature, the urine color, and then early neurological stimulation and APGAR scores that our puppies.
We know our low birth weight puppies have an 81% greater chance of death and that small puppies have an increased risk as well. Puppies, we used to say, could lose 10% of their body weight and be okay. But from the Neocare’s data, we know that if they lose more than 4% of their body weight after birth, that they have an eight-fold increased risk of death.
I talk a lot about small-for-gestational-age puppies, which means that these puppies are smaller than they typically would be. They’re not premature, they just are small. There are a lot of reasons for that. It can be that the female was sick. It can be that something went wrong with the pregnancy, like herpes. It can be that there are just too many puppies in the litter because the uterus only has so much real estate. If there are ten puppies in a uterus, it’s really meant to hold six. They’re crowded, just like those trees that have a little tiny bit of dirt out on the mountains in the rock. They’re tiny little scraggly puppies, so they’re not always successful.
It’s really important that we have the maternal nutrition, that we make sure our puppies get colostrum, if not colostrum, plasma and that we do give nutritional support either with getting them on the nipple to nurse or that we are bottle or tube feeding.
When it comes to preparing plasma, you want to warm it slowly in water that you have a thermometer in the thermal baths so that you don’t end up overheating the plasma. If you overheat it, like microwaving it or putting it in too hot water, you’re going to denature the proteins and basically just give them a very expensive injection. You need to give it with a needle and syringe. You can give it subcutaneously at any age or you can give it with a feeding tube in the first 12 hours.
Please don’t make-up sponge feed, please learn to tube feed. I can name a number of different reasons not to use a make-up sponge to feed. Number one, you’re not going to be able to measure the amount of formula. Number two, you can’t have anything that’s even close to sterile. You know, clearly the bottles aren’t completely sterile, but there’s bacteria that are going to grow in that sponge. They’re going to get fibers off or major pieces, there’s petroleum in that, they’re going to suck in a bunch of air. Use a bottle or use a tube feeding, but do not sponge feed.
The question lot of people have is do I need to supplement feed my puppy? A lot of people are reluctant because they think if they feed the puppy with a bottle or a tube, then the puppy is going to be full and it’s not going to crawl over to nurse. I’ll tell you, that’s not the case. If you feed a puppy and then put it back with its mother, you’re going to see it just motor right over and crawl back into the lineup and start to nurse on the female. And I think that’s really interesting. A lot of people just don’t get it. They think they’re going to hurt the puppy by feeding it and it’s really not true. Who at Thanksgiving has never had a piece of pie after they were really full? Of course, you eat your turkey, your stuffing, your cornbread, your potatoes and gravy, and then you have a piece of pie like you weren’t really hungry, but you ate it anyway. We know our puppies should gain 2 to 4 grams per day, per kilogram of anticipated adult body weight. So that’s a great formula. No matter what breed of puppy, you have to calculate how much they should be getting every day. And a puppy should double its birth weight by the time it is 7 to 10 days old. Low birth weight puppies certainly have risk and we know that toy breeds are 100 to 200 grams or a quarter of a pound, four ounces when they’re born. Large breeds are around a pound and giant breeds are over a pound. Very helpful.
How Do I Tube Feed My Puppy?
Tube feeding puppies makes a lot of people nervous. There are five tips that I’m going to give you that help you decrease the risk of a tube feeding accident. Now, if you feed enough puppies often enough, at some point you may have an accident because the puppy aspirated, the puppy, something went wrong with it. I want you to keep in mind that you can still have accidents that happen. But if you do these five steps, you’re going to decrease the risk. And I will encourage you to tube feed because you will lose more puppies to starvation than by a tube feeding accident, Every day I talk to people that have just not been willing or really aware that they need to feed the puppy.
So the five steps are:
1: Pre-measure the tube so that from the tip of nose to the last rib, that’s where you put the mark on the tube. The tube should go all the way to the last rib.
2: Pre-warm the puppy so that the formula is warm and the puppy is warm at least 96 degrees on the puppy. I don’t measure a thermometer on my milk. I use my wrist. I’m old school.
3: Pass with the chin down.
4: Pass with the tube to the left side.
5: And the most important thing is that you pinch the toes or the tail before you feed. If the puppy can cry, you’re not in the trachea, you’re not in the airway. If the puppy can’t cry, then pull out the tube. Stop. Go get a cup of coffee, come back and try it again.
When it comes to what size tube feeding tube to use, I use an eight French for the bigger puppies. So puppies over probably ten ounces and I use a five French for my smaller puppies. The amount to feed when tube feeding a puppy is one cc per one ounce of the body weight. So our four ounce puppy gets four ccs, an eight ounce puppy gets eight ccs, a 16 ounce puppy get 16 ccs, every 3 to 4 hours. At 2:00 in the morning when you’re up by yourself, I don’t want complicated math of how many kilocalories and how much is this and that and the other thing. This is what the stomach capacity of the puppy can accommodate.
Tube feeding should be done slowly but about 30 seconds is the length of time I would spend, 30 seconds, maybe 60, if it’s a really big puppy. It’s a good idea to lubricate the tube first, but to be really honest with you, I’m kind of lazy at 2:00 in the morning. So I typically dip the tube in formula in a bowl and then slide it down. If you want to use the lube, it’s never going to hurt anything.
So the only supplies you need are going to be puppy formula, a feeding tube and a syringe, a marker, a rectal thermometer, and a scale. All very simple things. Other than the feeding tube, you can pretty much run out and get any of these things. But make sure that you order your feeding tube before you have your litter of puppies, because if you get into trouble, there is no guarantee of overnight delivery anymore. Get this supply list ahead of time so that you are ready to go if you need to supplement a puppy. In my world, there are lots of reasons puppies can die, and unfortunately there are some that do. But no one should starve to death. Keep in mind that with support these puppies have a really good chance of survival. Please don’t let them just wither away.
If the puppy is strong enough to suckle well and effectively takes a bottle and you can measure that they’re sucking down enough formula, I think that’s great. I really like the Medi-Nursers, which are a 15 CC bottle and I also like the Miracle Nipple with the syringe on it. So those are really good ways to assess what the puppy’s taking. If you get an eight ounce bottle, it can be really hard on a small breed puppy to tell if they’re getting enough to eat. But if they’re happy to take a bottle, great. It’s just we’ll have some puppies that refuse a nipple. They’re either not well enough or they just don’t like the taste of the formula. And they just they just won’t take the bottle. But sometimes that tube feeding is the difference between losing a puppy and not somebody is wondering.
After you’re done feeding, if the female isn’t adequately stimulating them to urinate and have a stool, make sure you do that with your cotton ball. That picture of the stool on the right hand side is normal. It should be yellowish green, a seedy appearance to it. That’s an absolutely normal looking stool.
Please make sure that your puppies have adequate thermal support that you keep of clean and dry, that they get adequate nursing time, adequate nourishment. It’s really important that we do that.
The Canine Reproduction and Neonatology book, which goes through everything from pre-breeding screening for health screening through the breeding, the timing, the pregnancy, the whelping, the C-section, the neonatal care, the stud dog fertility, the very comprehensive guide. And it’s written not just for our veterinarians and our vet techs, but for my breeders as well. So be sure that you have access to this book.
The other book is Your Pandemic Puppy, which I make all of my people buy before they buy a puppy from me so that they know what they’re getting into. It goes through housebreaking and crate training and leash walking, preventing separation anxiety. But it also goes through the new puppy vaccinations, heartworm medications, the ages to spay and neuter. So there’s a lot of really current information in both of these books. Really helpful for you and your puppy buyers.
So before you have your litter, you want to make sure that you have your supplies and your equipment all lined up. I keep mine all in one nice ice chest so that I don’t have to run around the house and find all these things when I’m ready to go.
Some people ask about making their own milk replacer at home. Will it be good enough? The answer is No. You can do it if you need to in the middle of the night to get you through until you can get your Breeder’s Edge Foster Care, or one of the other products that are made to be puppy formulas. But the protein and fat content and the amino acids are not sufficient. I see a lot of problems with puppies with nutritional cataracts, if they were fed a homemade formula. We see a lot of diarrhea, poor weight gain. Don’t play that game. Please order the real thing that these companies have spent millions of dollars researching to get the right formula
Colostrum from the mother should be given to the puppies immediately. If the mother’s colostrum is not available you can use colostrum from another female that’s had puppies in the last 24 hours.
When it comes to probiotics for neonates, I recommend Breeder’s Edge Nurture Flora. It comes in a tube with that little dial on it, so it’s very sticky, very thick. I’ve used it and it goes directly on the puppy’s tongue and you can do that. It’s formulated specifically for newborn puppies. So it’s really the best product on the market. It’s got the most colony-forming units. It’s the most appropriate balance. Breeder’s Edge Nurture Flora should be given to all newborn puppies. Meanwhile, Breeder’s Edge Nurture Mate is a colostrum supplement that is sometimes used when puppies are a little bit weak and you just want to give them a bit of a boost.
When it comes to giving your female dog calcium during labor, I recommend Breeder’s Edge Oral Cal gel. I like to start it when the female goes into labor, I give it even prior to the puppy being born, but not until she’s actively in labor.
Vet Minute: When and How to Use a DeLee Mucus Trap
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How to Tube Feed a Puppy
With the proper equipment and care, you can feed a litter of newborn pups. Dr. Marty Greer shows step-by step how to tube feed puppies.
Newborn Puppy Care: Managing Neonates and High-Risk Puppies
Improve neonatal survival outcomes when puppies are in trouble. Dr. Greer provides resources to measure and strengthen the health of newborn puppies.
Puppy Enrichment: Placing Puppies in New Homes
In this webinar, Dr. Marty Greer suggests puppy enrichment activities and offers her recommendations regarding puppy enrichment, crate training puppies and puppy socialization so puppies are set up for success when they go to their forever home.
Written by: Marty Greer, DVM
Director of Veterinary Services
Marty Greer, Doctor of Veterinary Medicine, has 40+ years’ experience in veterinary medicine, with special interests in canine reproduction and pediatrics. She received her Doctor of Veterinary Medicine from Iowa State University in 1981. She’s served as Revival’s Director of Veterinary Services since 2019. In 2023, Dr. Greer was named the Westminster Kennel Club Veterinarian of the Year.