ORPHAN KITTEN CARE
A) Primary needs
1) Warmth
Kittens have virtually no body fat and do not shiver until they are about 3 weeks of age. Therefore, they must and rely on an external heat source, ideally the dam, for maintenance of normal body temperature. Orphans should be maintained in an environment at about 85oF (29.5oC) for the first two weeks of life, and about 80oF (26.5oC) for the subsequent two weeks. Warmed and cooler areas should be available, so the kittens can crawl to an area appropriate in temperature. Among surface sources of heat, circulating hot water blankets are best. Hot water bottles should be wrapped in towels and frequently changed. Regular heating pads may heat unevenly and more easily burn the fragile skin of neonates. Heat lamps are an excellent, safe way to provide radiant heat.
2) Hydration
Assess for hydration by (i) tackiness of mucous membranes - be aware that if there's milk in their mouth, their gums will feel slippery, (ii) color of urine - normal urine in neonates is clear so if it looks at all yellow, they're dehydrated, (iii) skin tenting? - less valuable because of lack of subcutaneous fat.
Fluids should be warmed before administration. Fluids can be given subcutaneously but will be taken up very slowly by that route. Intraosseous administration of fluids may be necessary in severely dehydrated, recumbent animals.
3) Nutrition
a) Type of diet
Milk is the primary diet of kittens up to three weeks of age. Do not feed milk-based products to animals with a body temperature less than 96 oF. At this low body temperature, ileus (lack of intestinal motility) permits souring of milk in the stomach rather than normal movement of milk into the small intestines. Chilled animals may be provided nutrition with a commercial veterinary nutritional product, such as Neutrical, rubbed on the gums and can be provided oral fluid and electrolytes with a commercial human product, such as Pedialyte.
Milk, composed of about 85% water, is the primary source of fluid for neonates and is vital for maintenance of normal hydration and fluid volume and provision of non-nutritive bioactive agents, such as enzymes, hormones and growth factors. An effort should always be made to find a lactating queen to support orphan animals. No commercial or homemade milk replacer contains all the components of bitch's or queen's milk. Goat's milk, a commonly described supplement for orphans, is a poor substitute for queen's milk. Feline milk replacers must contain a source of taurine for optimal growth to occur. Problems reported with feeding of either commercial or home-made milk replacers to puppies and kittens include small, focal cataracts due to deficiencies in vitamins or amino acids that resolve after weaning, and slower growth rate due to lack of enzymes necessary for fat digestion. Hand-raised kittens achieve the same size as littermates allowed to nurse by several months of age. The decreased caloric density of formulas makes it difficult to provide orphans with an adequate number of calories without inducing diarrhea. If feeding induces diarrhea, the formula can be diluted 1:2 with electrolyte solution until the neonate can tolerate it.
b) Amount to be fed
Amount to be fed varies with caloric density of the formula, and age and weight of the animal. Kittens should receive 100-175 kcal per pound (220-380 kcal/kg) daily, split into 4-6 feedings. Feeding frequency can be decreased to 3 times daily after the orphan reaches 2 weeks of age. Consider, for example, a diet that contains 237 kcal/cup, which equals 30 kcal/fl oz (3 kcal/ml). Kittens require 100-175 kcal/pound daily; a 4 oz (1/4 pound = 113 gm) kitten requires 25-44 kcal daily. The amount to be fed daily is 0.8 - 1.5 fl oz (8-15 ml). This yields, for 4 daily feedings, a per feeding volume of 0.2 - 0.4 oz (2-4 ml). Commercial milk replacers often bypass discussion of calories, providing volume instructions only. An example is the kitten milk replacer, KMR (Pet-Ag, Elgin IL; 2 T / 4 oz (10 ml / 125 gm) daily). If volume is used to determine amount to be fed, regular weighing of the kitten is essential.
The kitten should have been weighed at birth, and should be weighed daily thereafter. Kittens should weigh about 3.5 oz (100 gm) at birth. Slight weight loss may occur in the first 24 hours of life. After that, the kitten should gain weight daily, doubling their birth weight by 7-10 days of age. Kittens should gain 1.8 - 3.5 oz (50-100 gm) weekly.
c) Feeding technique
The formula should be warmed to 95-100oF (35-38oC) when feeding 1-2 week old animals. Equipment for feeding of pediatric animals includes spoons, droppers, bottles, or tubes. Spoon- and dropper-feeding are dangerous since the limited gag reflex of puppies and kittens easily permits aspiration of formula into the lungs.
Bottle-feeding poses less risk of aspiration and more readily satisfies the neonate's need to suckle. Small bottles marketed for animals or bottles intended for premature human infants may be used. The hole in the nipple should allow milk to ooze slowly. The bottle should never be squeezed to force expulsion of milk while the animal is nursing. Place the kitten on its ventrum in your hand or on a surface to which it can cling, such as a towel. Open its mouth gently and insert the nipple. Hold the bottle upward at about a 45 degree angle; gentle pulling on the bottle to keep the nipple taut in the animal's mouth promotes vigorous suckling.
Tube-feeding is quick. Caution must be used to ensure proper placement of the tube into the gastrointestinal tract and to prevent overflowing and regurgitation. The feeding tube varies in diameter and length with age. A #5 French feeding tube should be used in animals weighing less than 300 gm and a #8-10 French feeding tube used in animals weighing more than 300 gm. Measure the length of the feeding tube by marking off 75% of the distance from the animal's last rib to the tip of its nose. This length ensures placement in the stomach without kinking of the tube within the gastrointestinal tract. Length should be rechecked and adjusted weekly. The animal should be held horizontally on its ventrum. Advance the tube over the tongue. If the kitten cries once the tube is placed, you know you're not in the trachea. The warmed formula is gently expelled through the tube with a syringe. If milk bubbles through the nostrils, stop immediately and check placement of the tube. Monitor gastric distension; average stomach capacity in neonates is about 0.7 fl oz (4 tsp) per pound (40 ml/kg).
d) What about colostrum?
Ascertain, if possible, whether the kitten has ingested colostrum. More than 90% of maternal antibodies are passed to the neonate via the colostrum. Neonates should be encouraged to begin nursing within 2-3 hours of birth. Maximal absorption of antibodies through the intestine occurs at 8 hours after birth, and decreases significantly by one day of life. Serum IgG concentrations are low at birth, increase rapidly to a peak 18 hours after ingestion of colostrum, and then decline to a nadir at 3-4 weeks of age. If a kitten has not ingested colostrum, antibodies can be provided by subcutaneous administration of serum from the dam or another immunocompetent animal in the household. In a study of 43 kittens, comparing subcutaneous administration of antibody-rich serum to suckling, it was demonstrated that both techniques significantly increased protective antibody concentrations in kittens, compared to a control group that received no antibodies. The empirical dose is 15 ml of serum, given subcutaneously as 5 ml boluses at birth and 12 and 24 hours later. Finally, be aware that composition of milk in queens does not vary over the lactation, such that queens late in lactation still contain large amount of antibody in their milk and could provide passive immunity for kittens within the first 24 hours of life. Early vaccination may be warranted in kittens that did not receive adequate amounts of colostrum.
e) Weaning
Weaning, introduction of solid food, begins at 3-4 weeks of age in kittens. Young animals need more nutrients to allow for normal growth and development but take longer to ingest food and have a smaller digestive capacity, necessitating feeding of an energy dense, highly digestible food. Food should be offered as a gruel initially, formed by thoroughly blending 1 part dry food to 3 parts formula or 2 parts canned food to 1 part formula for kittens. Fewer problems with post-prandial gastric distension occur if the food is thoroughly soaked. Fresh water always should be provided as well. Gradually mix less water or formula with the food until the kitten is eating dry food exclusively. Weaning usually is complete by 6-8 weeks of age. By the time the animal is weaned, it should have a body weight roughly 6-10 times its birth weight.
4) Elimination
Gently massage the genitalia with a cotton ball or soft washcloth after every feeding, to stimulate urination and defecation. Normal kitten feces often are mustard yellow in color and pasty.
Constipation is considered to be present if the animal has not defecated in over a day or if very firm stool is palpable in the colon. A gentle enema with warm water containing just a tiny bit of dishwashing liquid, using a red rubber tube, may be performed to help break up firm stool and encourage passage. If recurrent constipation occurs, the milk replacer should be diluted. Some individuals report success with feeding kittens small amounts of plain yogurt as well; this can be spooned into their mouth or diluted with water and passed through a feeding tube.
5) Handling
It has been demonstrated that kittens that are regularly handled are tamer and more readily adopted after weaning. After stimulation of urination and defecation, rub the kitten with a warm, slightly rough towel. This simulates grooming by the mother. It also helps keep the kitten clean and makes you aware of any disease conditions, such as suckling injury from neonates or fleas.
B) Landmarks
Eyelids open at about 7-10 days of age - The eyes may appear cloudy when first open due to corneal edema; this should clear within 1-2 days. Eye color will change with age, stabilizing by about 3 months of age.
Ear canals open and pinnae become erect at about 2-3 weeks of age.
Kittens will first attempt to stand at about 2-3 weeks of age and should be mobile by 3-4 weeks of age.
Teeth first emerge at 3-4 weeks of age.
C) Common problems
1) Diarrhea - Diarrhea often occurs secondary to overfeeding of neonates or disruption of the normal gastrointestinal environment with changes in diet or antimicrobial therapy. Primary bacterial diarrhea also has been reported. Treatment is supportive care with fluid therapy and assessment of the feeding schedule. Intestinal parasites are common in young animals, especially those born in warm climates or in closely managed facilities. In kittens, roundworms (Toxocara canis) are very common. Roundworms can pass transplacentally in late gestation. Within infected kittens, the larvae may migrate to the lungs and liver, causing a non-productive cough and poor weight gain. Treatment of kittens 2 weeks of age or older is with pyrantel pamoate (5-10 mg/kg per os once daily for 2-3 weeks). Use of piperazine is not recommended in kittens. Coccidiosis can occur in kittens. Infection usually is asymptomatic and self-limiting. If diarrhea occurs, treatment may be instituted with sulfadimethoxine (30 mg/kg once daily in kittens weighing at least 1 kg) until signs regress. Similarly, infection with Giardia sp. usually is asymptomatic and self-limiting. If necessary, kittens can be treated with either metronidazole (30 mg/kg per os once daily for 7-10 days or 25 mg/kg per os twice daily for 5 days, then 10 mg/kg twice daily) or fenbendazole (50 mg/kg per os once daily for 3-7 days). Pentatrichomonas hominis is a trichomonad parasite, reported to cause diarrhea in some affected kittens.
2) Upper respiratory infections - A complex of respiratory diseases occurs in cats caused by viruses, such as rhinotracheitis and calicivirus, bacteria including Bordetella bronchiseptica and Chlamydia psittaci and, rarely, fungal organisms. Queens often are asymptomatic until stressed by queening, at which time organisms are shed and the less immunocompetent kittens infected. Clinical signs vary from mild conjunctivitis and serous oculonasal discharge to sneezing, tenacious oculonasal discharge, self-trauma due to pawing at the face, and respiratory distress. The condition usually is self-limiting and resolves in 10-14 days. Antibiotic therapy may hasten resolution of clinical signs. Nursing measures include frequent cleaning of the face with warm water and increased humidification of air in the environment; be cautious with the latter as some kittens cannot tolerate very humid air and will become dyspnic. Calicivirus infection also may be associated with mononuclear cell infiltration of joints, causing a lameness that usually is self-resolving; this is sometimes termed "limping kitten syndrome."
3) Fleas - Fleas are a common external parasite of young animals. Severe flea infestation can cause anemia, with clinical signs including pale mucous membranes, lethargy, tachycardia, and collapse and death. Fleas also can transmit tapeworms. The preferred treatment for fleas in animals less than 2 months of age is thorough bathing and grooming with a flea comb. Dipping and/or systemic treatment is not recommended for animals less than 3 months of age.
4) Septicemia - Septicemia is system-wide infection with one or more bacterial organisms. Entry occurs most commonly via the umbilicus. The animal may be predisposed to septicemia by inadequate ingestion of colostrum or concurrent disease of the neonate or dam. Gram-negative organisms are most commonly involved, with E. coli the most prevalent isolate. Clinical signs vary with the organ(s) affected. Reported syndromes include gastroenteritis with foamy vomitus, liquid diarrhea, reddening of the anus, rapid dehydration and death, pyelonephritis with abdominal pain, fever, dehydration and hematuria, omphalitis, conjunctivitis, pneumonia with respiratory distress and cyanosis, and non-specific weakness, vocalization and dehydration. Acute respiratory distress syndrome, characterized by life-threatening non-cardiogenic pulmonary edema, may occur secondary to septicemia, as may sloughing of the extremities, perhaps due to concurrent disseminated intravascular coagulation (DIC), tissue hypoxemia or vasculitis. Putative diagnosis is based on clinical signs, presence of normocytic normochromic anemia, thrombocytopenia, and mild to moderate neutrophilia with a left shift on complete blood count, and hypoglycemia on serum chemistry profile. Definitive diagnosis requires blood culture. Urine culture may be positive in some septicemic animals. Septicemia is commonly diagnosed at necropsy. Treatment of septicemia requires fluid therapy to counter dehydration and hypoglycemia (balanced electrolyte solution with 5% dextrose and KCl supplement if serum potassium concentrations are less than 2.5 mEq/L), oxygen therapy for management of tissue hypoxemia, and appropriate antibiotic therapy. Penicillins and cephalosporins are appropriate empirical choices pending culture and sensitivity results.