Practical neonatology · Puppy and kitten · Birth to 3 weeks
A short, structured examination adapted to physiology that changes from day to day
Public information: assessment principles and warning signs. Invasive procedures, treatments and dosages require veterinary examination.
Seek urgent veterinary care
- open-mouth breathing, apnoea, marked effort, abnormal noise, grey or blue tongue/mucosae;
- a cold, limp or poorly responsive neonate that cannot find the teat or suck;
- very weak or persistent crying, isolation, unusual agitation followed by depression;
- failure to gain weight, ongoing weight loss or a rapid fall between comparable measurements;
- marked abdominal distension or pain, vomiting/regurgitation, diarrhoea, blood, or suspected absence of urine/faeces;
- a moist, red, painful, foul-smelling or discharging umbilicus;
- several affected neonates, an unwell dam, reduced milk, abnormal vaginal discharge or a hot painful mammary gland.
Do not force-feed a cold, very weak or dyspnoeic neonate, or one with doubtful swallowing. Controlled warming, oxygenation and stabilisation must be organised by the veterinary team.
1. A neonate is not a small adult
During the first weeks, thermoregulation, cardiovascular responses, renal function, energy reserves, immunity and the nervous system are still immature. Values change rapidly with age, species, breed, mode of delivery, environment and measurement method. Adult reference intervals cannot be applied mechanically.
Hypoxia, hypothermia, insufficient energy intake, dehydration and infection readily worsen one another. An affected neonate may simply nurse less, move less, stop gaining weight or move away from the group. Waiting for dramatic signs loses valuable time.
Do not ask only whether a value is “normal”. Ask whether it fits age and context, whether it is moving in the right direction, and whether this neonate behaves like its littermates.
| Feature | More reassuring | Needs assessment | Emergency |
|---|---|---|---|
| Behaviour | Wakes to nurse, seeks warmth, settles afterwards | Less vigorous, shorter feeds, separates from the litter | Limp, unresponsive, very weak or continuous cry |
| Breathing | Regular at rest, closed mouth, no effort | Persistently faster, noisy or asymmetric | Apnoea, open mouth, cyanosis, marked effort |
| Feeding and weight | Effective suckling, soft abdomen, rising curve | Inadequate gain, unrest after feeds | Stops suckling, regurgitates, rapid weight fall |
| Elimination and umbilicus | Light urine, feeding-compatible stools, dry umbilicus | Repeated soiling, moist or irritated umbilicus | Blood, marked distension, purulent umbilicus, suspected anuria |
2. At birth: assess transition without delaying effective care
Immediately after vaginal delivery or caesarean section, the purpose is to identify a neonate failing cardiorespiratory transition. The veterinary Apgar score combines five components: heart rate, respiration, mucous membrane colour, tone/movement and reflex response. It structures observation and helps monitor the response to care.
The score was developed and studied mainly in puppies, then adapted to kittens. Timing, delivery type, maternal medication, breed and observer affect it. It must never delay airway care, stimulation, controlled warmth or support of an obviously apnoeic neonate. Nor does it predict health over the following days by itself.
| Component | What it reflects | Major limitation |
|---|---|---|
| Heart rate | Circulatory adaptation and severity of hypoxia | Neonatal bradycardia is serious; measurement must be rapid and reliable |
| Respiration | Onset, regularity and ventilatory effort | Chest movement does not guarantee effective oxygenation |
| Mucous membrane colour | Apparent perfusion and oxygenation | Lighting, pigmentation, anaemia and vasoconstriction affect interpretation |
| Tone and movement | Overall vigour and neurological response | Temperature, prematurity, hypoxia and maternal sedation interfere |
| Reflex response | Reactivity to an appropriate stimulus | Technique and observer experience influence the result |
A prospective study published in August 2026 examined 40 kittens from 11 litters within 12 hours of birth. Higher Apgar and reflex scores were associated with survival to four weeks. This supports their clinical use, but the small cohort cannot establish universal thresholds. Lactate, pulse oximetry and the appearance of amniotic fluid likewise provide context rather than a stand-alone verdict.
After the delivery room. A reassuring Apgar score does not remove the need to weigh, observe nursing and recheck the neonate. Conversely, an initially low score may improve quickly with appropriate support.
3. Prepare the examination and observe first
Examine the neonate quickly and calmly in a warm room, on a clean, warmed surface. Prepare equipment before lifting it from the nest: a precise scale, a thermometer suitable for low readings, paediatric stethoscope, light source, gauze and monitoring sheet. Clean hands and equipment between litters and, in an infectious setting, between individuals.
Observe in the nest before handling: position, movement towards the dam, nursing quality, chest excursions, vocalisation, sleep and interaction with littermates. Note whether the neonate is repeatedly pushed away, trapped or remote from the heat source. A short video obtained before handling can help the veterinarian.
History includes time and type of delivery, obstetric difficulty, maternal medication, birth order, initial weight, access to colostrum, previous losses, individual growth, supplements given and the dam’s progress.
Handle gently, supporting the body and head. Never suspend by a limb or compress the chest. Keep separation as brief as possible, especially in a cold or low-birth-weight neonate.
4. Breathing, heart, mucosae and perfusion
Look before listening
Count chest movements while the neonate is settled. Rate changes with age, sleep, temperature, vocalisation and handling; effort, regularity and trend matter as much as the number. Normal breathing is quiet, with a closed mouth and no marked recession or abdominal paradox. Repeated sneezing, discharge, crackles, asymmetry, pauses, open-mouth breathing or cyanosis require assessment.
Bradycardia is particularly concerning
The neonatal heart relies strongly on rate to maintain cardiac output. A low rate, especially with hypothermia, poor colour, apnoea or weakness, indicates severity. Auscultation also looks for a murmur, irregular rhythm, abnormal lung sounds and side-to-side differences. A murmur does not always mean a severe malformation, but warrants planned reassessment.
Interpret mucous membrane colour and capillary refill together, accounting for pigmentation and lighting. Very pale, grey or blue mucosae, weak pulses or cold extremities are not signs to simply monitor at home.
In brachycephalic breeds, airway conformation and caesarean delivery may influence early adaptation. Monitoring should be closer without dismissing noisy or open-mouth breathing as “normal for the breed”.
5. Temperature, perfusion and hydration
Body temperature is naturally lower than in adults and rises over the first weeks. It is strongly influenced by nest temperature, humidity, age, measurement site and technique. Interpret one value alongside behaviour, nursing, heart rate and a trend obtained under comparable conditions.
Low temperature reduces digestion, motility and cardiorespiratory responses. Warming must be gradual and controlled. Direct or excessive heat without an escape zone risks burns and dehydration. The dam must be able to move away from the warm area.
Skin tenting is unreliable because neonatal skin and body-water distribution differ from those of adults. Assess hydration using several features: mucosal moisture, perfusion, heart rate, urine production, behaviour, nursing and especially weight change. Low urine specific gravity can be physiological at this age and does not alone prove renal disease.
Measure without causing harm. A temperature obtained after prolonged struggling or chilling is less useful than a gentle, repeatable measurement interpreted in context.
6. Nursing, abdomen, elimination and weight
Watch an actual feed
An effective neonate locates the mammary gland, latches, produces rhythmic suction and settles afterwards. Being attached is not the same as swallowing. Clicking, milk from the nostrils, coughing, fatigue, poor swallowing, persistent unrest or rapid abandonment of the teat raise concern for weakness, hypothermia, cleft palate, respiratory disease, pain, inadequate milk or maternal disease.
Palpate without squeezing
The abdomen is normally soft and moderately full after a feed. Tense distension, pain, a mass, abnormal sounds, vomiting or diarrhoea require assessment. Confirm a patent anus and observe urine and faeces without interpreting colour outside feeding context. The dam normally stimulates elimination, so “no urine seen” must be distinguished from maternal cleaning.
The weight curve is part of the clinical examination
Use the same scale at the same time relative to feeding and identify each neonate reliably. Birth weight, percentage change and slope across several readings are more informative than a generic “normal” weight. Persistent stagnation or loss often precedes visible illness.
Related article: birth weight and growth monitoring in puppies and kittens.
7. Tone, reflexes, movement and pain
Neonatal neurological examination must account for maturation. Observe tone, symmetry of movement, crawling, righting, orientation towards touch or warmth, rooting and suck strength. A weak response may reflect hypothermia, hypoxia, low energy availability, infection, prematurity, congenital disease or medication; it does not identify the cause on its own.
Rooting, suckling and righting reflexes are useful when assessed gently and consistently. Asymmetry, loss or deterioration matters more than rigid comparison with a cut-off. Eyes and ear canals are normally closed at first; never force them open.
Pain or distress can cause crying, agitation, tension, abnormal posture, altered breathing, withdrawal from touch, reduced suckling and eventually exhaustion. There is no universally validated behavioural pain score for all newborn puppies and kittens. A bilingual prototype in Dr Lévy’s working documents, adapted from human neonatal tools, remains a research concept and is not presented here as a validated diagnostic scale.
An unusually quiet neonate is not necessarily comfortable. Exhaustion, hypothermia or hypoxia can suppress vocalisation.
8. Head-to-tail examination: do not miss subtle malformations
| Region | Check | Reason |
|---|---|---|
| Head and mouth | Symmetry, breed-appropriate fontanelle, nostrils, tongue, entire palate, jaws | Cleft palate, atresia, nasal obstruction, craniofacial anomaly |
| Eyes and ears | Closed lids without swelling/discharge; do not force lids or canals | Subpalpebral infection, trauma, developmental anomaly |
| Thorax | Shape, symmetry, excursion, sternum, resting breathing | Pectus excavatum, flattening, hernia, cardiorespiratory disease |
| Abdomen and umbilicus | Softness, pain, mass, hernia, dry clean umbilicus | Omphalitis, hernia, digestive or urinary anomaly |
| Perineum | Anal opening, vulva/prepuce, urine stream if observed, soiling | Anal atresia, urogenital anomaly, diarrhoea |
| Limbs and spine | Digits, posture, length, mobility, pain, tail, spinal line | Deformity, trauma, spina bifida, locomotor syndrome |
| Skin and coat | Colour, lesions, oedema, bruising, parasites, moisture | Birth trauma, infection, anasarca, unsuitable environment |
A visible anomaly should trigger a search for associated defects. An apparently closed palate does not exclude every swallowing disorder. Conversely, a small nonpainful umbilical hernia has a different urgency from an inflamed painful umbilicus.
9. Examine the dam, litter and nest
A neonate cannot be interpreted in isolation. A whole restless litter may lack warmth or milk; several deteriorating neonates suggest a maternal, environmental or infectious factor. One affected individual also raises the possibility of malformation, trauma, poor teat access or individual disease.
- Dam: general condition, temperature when indicated, appetite, hydration, pain, maternal behaviour, vaginal discharge, uterus, mammary glands, milk quality and availability.
- Litter: number, weights and trajectories, order of onset, nursing vigour, competition, previous deaths and shared abnormalities.
- Environment: temperature measured at neonate level, humidity, draughts, hygiene, nonslip surface, crushing risk, crowding and visitor hygiene.
Record recent changes in milk replacer, feeding procedure, disinfectant, nest location or caregiver. Keep product containers and powder identification so preparation, storage and use can be checked.
A litter diagnosis often requires two examinations in parallel: the affected neonate and its dam. This is one reason a coordinated specialist opinion may avoid a series of costly empirical trials.
10. Select targeted diagnostic tests
Choose tests to answer a clinical question, after stabilisation when needed. Interpretation requires age- and species-appropriate reference information. A value outside an adult interval may be physiological in a neonate, and the reverse is also possible.
| Clinical question | Possible tests | What they cannot show alone |
|---|---|---|
| Cold, weak, poor suckling | Repeated temperature, blood glucose, weight, dam/litter examination | One glucose value does not reveal cause or trajectory |
| Compromised at birth | Apgar, pulse oximetry if signal quality is reliable, lactate/blood gas where available | A number must not delay required ventilation or oxygen support |
| Respiratory/cardiac concern | Pulse oximetry, radiography, thoracic or cardiac ultrasound, CT in selected cases | Imaging must be balanced against transport, stress and stability |
| Suspected infection | Age-adapted haematology/biochemistry, targeted sampling, culture, cytology, hypothesis-led PCR | Positive culture may be contamination/colonisation; positive PCR does not always prove causality |
| Litter mortality | Prompt post-mortem examination, histology, bacteriology and targeted tests on carefully selected subjects | Delayed or poorly preserved samples greatly reduce diagnostic value |
In a fragile neonate, sample volume, temperature during testing and time away from the nest form part of the benefit–risk assessment. Unfocused “complete” panels can generate hard-to-interpret findings while using a disproportionate blood volume.
Recent studies of lactate, placentation, amniotic fluid and multimodal scores refine perinatal risk stratification. They do not replace serial examination, nursing observation or the weight curve.
11. Organise home or breeding-unit monitoring
The best chart is simple, time-stamped and individual. Its purpose is to reveal a trend before an emergency becomes obvious.
| At birth | At least daily | Record immediately |
|---|---|---|
| ID, sex, time/type of delivery, difficulty, weight, visible anomaly, initial vitality if assessed | Weight under comparable conditions, nursing quality, behaviour, breathing, observed urine/faeces, umbilicus | Supplement, milk or nest change, maternal treatment, new sign, time of call and advice received |
After a caesarean section, low birth weight, poor colostrum intake, maternal disease or any high-risk delivery, the veterinarian should individualise monitoring frequency. More handling is useful only when it leads to clear decisions.
Frequently asked questions
Is it normal for a neonate to sleep almost all the time?
Should every neonate have its temperature taken every day?
Can I use an Apgar score at home?
Does a high respiratory rate always mean pneumonia?
Can skin tenting diagnose dehydration?
Does meconium-stained fluid always mean fetal distress?
When is a specialist opinion useful?
Specialist advice
A deteriorating litter needs a coordinated assessment
Dr Xavier Lévy consults near Toulouse at CRECS and at Bordeaux Sud. French- or English-language support can also be arranged with the primary veterinarian, within the applicable regulatory framework.
12. References and level of evidence
Dr Xavier Lévy’s personal sources consulted: Neonatal disease from diagnosis to treatment — Salzburg 2026, final (September 2026), Neonatal diseases in dogs and cats (April 2026), and Neonatal Pain Assessment EN/FR (August 2025). Veterinary-only procedures and dosages were not reproduced. The last document is explicitly a research prototype adapted from human tools and is not validated in puppies or kittens.
- Thévenet M. La pathologie néonatale du chaton : mémento à l’usage du vétérinaire. Veterinary thesis, ENVA, 2007. Full personal copy consulted for examination structure; older data were compared with recent publications.
- Pereira KHNP et al. Neonatal Clinical Assessment of the Puppy and Kitten: How to Identify Newborns at Risk? Animals. 2024;14:3417. Contemporary clinical review and therefore secondary evidence. DOI.
- Veronesi MC et al. An Apgar scoring system for routine assessment of newborn puppy viability and short-term survival prognosis. Theriogenology. 2009;72:401–407. Foundational canine study. PMID 19476989.
- Vassalo FG et al. Topics in the routine assessment of newborn puppy viability. Top Companion Anim Med. 2015;30:16–21. Review of methods and limitations. PMID 26041592.
- Thorogood J et al. EXPRESS: Prediction of survival in neonatal kittens using APGAR and reflex scoring. J Feline Med Surg. 2026. Prospective cohort of 40 kittens from 11 litters, with eight deaths by four weeks. DOI.
- Silva LCG et al. Topics in the routine assessment of newborn kitten vitality: Apgar score, reflexes and complementary assessments. J Feline Med Surg. 2022. Comparison of eutocic and emergency-caesarean kittens. PMID 35352984.
- Rodríguez A et al. Blood lactate concentration and neonatal viability following emergency caesarean section in dogs. Theriogenology. 2025;241:117437. Study of 118 neonates from 28 bitches; lactate is an adjunct, not a universal threshold. DOI.
- Sato K et al. Effect of meconium-stained amniotic fluid on hematological parameters and clinical status of term neonatal puppies. Anim Reprod Sci. 2026;292:108255. Small study of 15 puppies that does not establish adverse outcome from staining alone. DOI.
- Mila H et al. Monitoring of the newborn dog and prediction of neonatal mortality. Prev Vet Med. 2017;143:11–20. Growth, vitality and mortality risk. PMID 28622787.
- Veronesi MC et al. Evaluation of newborn canine viability by means of umbilical vein lactate measurement, Apgar score and uterine tocodynamometry. Theriogenology. 2010;74:1187–1196. Birth measurements and contextual limitations. PMID 20615542.
Limitations: many neonatal studies are single-centre, performed only around birth, or include small samples. Reference values depend on species, age, breed and method. Associations do not show that one isolated parameter caused the outcome.
Rights: text © Xavier Lévy 2026. Third-party publications, trademarks, images and data remain the property of their respective owners. Reproduction without permission is prohibited.