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The RECOVER initiative brought together librarians, veterinary professionals and subject matter experts in small animal reproduction and used a systematic approach to provide evidence- and consensus based treatment recommendations for newborn puppies and kittens requiring resuscitation at birth. In this process, we answered 28 prioritized PICO questions, and from these developed 59 clinical guidelines on supportive measures for newborn puppies and kittens in the first moments after birth. Veterinary professionals and other stakeholders concerned in the care of puppies and kittens at birth are invited to comment on these guidelines. Commenting is open for 2 weeks (until May 26, 2025), and community feedback will be reviewed and considered in finalizing the guidelines. Your comments are important to us!
I suggest the following approach:
For the RECOVER Newborn Resuscitation Guidelines Project
Manuel Boller, Dr med vet, MTR, DACVECC
7 Comments
Please consider these definitions, as they are critical to understand the target population to which these newborn resuscitation guidelines apply. So please review before commenting on the clinical guidelines.
9 Comments
Please comment on the Newborn Resucitation algorithm. Please note that while the algorithm can be used a cognitive aid during resuscitation of newborn dogs and cats, it might be more useful as a pre-prief of resuscitation teams just prior to delivery.
Most of the PICO questions address a decision or action point in the algorithm, so please consider the clinical recommendations in the context of the algorithm.
7 Comments
This is a summary of all 28 PICO questions and the associated 59 treatment recommendations. The evidence and the justifications in support of these recommendations can be found in the worksheet documents that can be accessed and commented on seperately.
In newborn dogs and cats that require resuscitation (with or without CPA) (P), how does initiating PPV at any other heart rate target (I), compared with HR less than 100 bpm (C) improve outcome (O)?
In newborn dogs and cats that require resuscitation in which PPV has been initiated (P), how does starting chest compressions below any other heart rate (I), compared with less than 60 bpm (C) improve outcome (O)?
In newborn dogs and cats that require resuscitation with PPV (P), how does administration of longer inspiratory times, higher inflation pressures and PEEP (I), compared with an inspiratory time of 1 second and a peak inspiratory pressure of 20 cm H2O and no PEEP (C) improve outcome (O)?
In newborn dogs and cats without CPA that require resuscitation (P), how does the use of electrocardiography (ECG) (I), compared with any other heart rate assessment (e.g., pulse oximetry, apex beat palpation, auscultation) (C), improve outcome (O)?
In newborn dogs and cats without CPA that require resuscitation and with the need for intermittent PPV (P), how does ventilation via endotracheal intubation (I), compared with using a tight fitting face mask (C), improve outcome (O)?
In newborn dogs and cats that require resuscitation with PPV (P), how does administration of longer inspiratory times, higher inflation pressures and PEEP (I), compared with an inspiratory time of 1 second and a peak inspiratory pressure of 20 cm H2O and no PEEP (C) improve outcome (O)?
In newborn dogs and cats that do not demonstrate adequate spontaneous ventilation efforts at birth (P), how does administration of doxapram (I), compared with no administration of doxapram (C), improve outcome (O)?
In newborn dogs and cats that do not demonstrate adequate spontaneous ventilation efforts at birth (P), how does no needle stimulation (I), compared with insertion of a needle in the nasal philtrum (GV26) (C), improve outcome (O)?
In newborn dogs and cats that require resuscitation at birth (P), how does clearance of the upper airway by suctioning (I), compared with no clearance (C), improve outcome (O)?
In newborn dogs and cats that require resuscitation at birth (P), does clearance of the upper airway by any other method (I), compared with airway clearance with suctioning (C), improve outcome (O)?
In newborn dogs and cats that require resuscitation at birth (P), how does no temperature control (I), compared with maintenance of normothermia (95° to 99° F [35° to 37.2° C]) (C), improve outcome (O)?
In newborn dogs and cats with cardiopulmonary arrest (P), how does any other specific rate for external chest compressions (I), compared with a compression rate of 120/minute (C), improve outcome (O)?
In newborn dogs and cats receiving chest compressions (P), how does other compression to ventilation ratios (e.g., 30:2; 15:2, 9:3, 5:1) (I), compared with a compression:ventilation ratio of 3:1 (C), improve outcome (O)?
In newborn dogs and cats receiving chest compressions and PPV via endotracheal tube (P), how does pausing chest compression to administer breaths (I) compared with simultaneous ventilations and chest compressions (C), improve outcome (O)?
In newborn dogs and cats that require resuscitation (P), how does the use of no external physical stimulation (I), compared with tactile stimulation (e.g., rubbing) (C), improve outcome (O)?
In newborn dogs and cats receiving chest compressions (P), how does the administration of ventro-dorsal chest compressions (i.e., over the sternum) (I) compared with lateral chest compressions (C), improve outcome (O)?
In newborn dogs and cats receiving chest compressions (P), how does another chest compression depth (I) compared with 1/3 of chest width (C), improve outcome (O)?
2 Comments
In newborn dogs and cats receiving chest compressions (P), how does ventilation with any other oxygen concentration (I), compared with 100% oxygen (C), improve outcome (O)?
In newborn dogs and cats that require resuscitation (with or without CPA) (P), how does routine parenteral administration of dextrose (I), compared with targeted administration of dextrose (C), change outcome (O)?
In newborn dogs and cats that require resuscitation after Caesarian birth (with or without CPA) (P), how does no administration of antagonists to sedatives given to the dam (e.g., naloxone) (I) compared with parenteral administration of antagonists (C) improve outcome (O)?
In newborn dogs and cats with very low heart rate (e.g., HR < 50 bpm) despite adequate PPV and chest compressions (P), how does routine parenteral administration of no epinephrine (I), compared with epinephrine administration (C), improve outcome (O)?
In newborn dogs and cats with a very low heart rate (e.g., HR < 60 bpm) despite adequate PPV and chest compressions (P), how does a different dose of IV/IO epinephrine (I), compared with 0.01 mg/kg IV/IO (C), improve outcome (O)?
1 Comment
In newborn dogs and cats that require resuscitation and are bradycardic (P), how does routine parenteral administration of atropine (I), compared with no atropine administration (C), improve outcome (O)?
In newborn dogs and cats that require resuscitation that are in CPA (P), how does routine parenteral administration of atropine (I), compared with no atropine administration (C), improve outcome (O)?
In newborn dogs and cats receiving chest compressions (P), how does continuation of well executed chest compressions beyond 10 minutes (I) compared with discontinuation of chest compressions after 10 minutes (C) improve outcome (O)?
In newborn dogs and cats after ROSC (P), how does routine parenteral administration of glucose (I), compared with targeted administration of glucose (C), improve outcome (O)?
In newborn dogs and cats with ROSC that remain comatose (P), how does permissive hypothermia to maintain core temperature below normal (I), compared with active warming to maintain or achieve normothermia (C), improve outcome (O)?
In newborn dogs and cats with ROSC that are spontaneously hypothermic (P), how does rewarming at a rate greater than 1 C/hour (I) compared with rewarming at a rate of 1 or less C/hour (C) improve outcome (O)?
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