Kitten programs 2.0 part 1: Re-examining medical protocols for neonates
Kitten season is almost here, and since we know that neonates have the highest mortality rate of any shelter or rescue population, we reached out to a few experts to see what’s new in terms of providing medical care for them. Whether you already have a kitten program in place or are thinking about adding one, here are some suggestions for rethinking medical protocols. (A quick disclaimer for the content in this week’s Kitten programs 2.0: Always consult your veterinarian before making changes to your medical protocols.)
To tube-feed or not to tube-feed…?
Feeding neonates is the most elemental aspect of their care and is typically done with a bottle or syringe. If none of your volunteers or staff members know how to tube-feed, however, consider changing that. Sure, it can be scary, but our experts agree that tube-feeding gives you an edge—particularly with babies in crisis.
“It's a tool you should have in your toolbox for those kittens likely going to die otherwise,” says Erin Katribe, DVM, MS, medical director for Best Friends Animal Society. “It’s quicker and more efficient than dribbling one drop of formula at a time into their mouths and waiting for them to maybe swallow it."
“Tube-feeding is a lot safer than bottle feeding,” agrees Heather Kennedy, DVM, director of feline operations at Kansas City Pet Project (KCPP). “I’ve never seen a kitten aspirate from tube-feeding, but I have necropsied bottle-fed kittens who died of aspiration.”
Heather regularly trains volunteers on the process and soothes their fears by stressing how difficult it is to put the tube into the trachea instead of the esophagus.
“I show volunteers the right length of tube needed to reach the stomach, and kittens typically swallow the tube once it’s at the back of the throat,” says Heather, who even counts two 16-year-old girls as recent graduates of her training. “The esophagus is essentially a floppy tube, so when you pull back on the plunger of the syringe, it will collapse around the holes in the feeding tube. That closes off any air and makes it impossible to pull back anymore, and you know you’re in the right place.”
All our experts have taught people how to tube-feed.
“It’s terrifying to learn but if you're doing it correctly, it's a lot safer than attempting to syringe feed and is a huge time-saver,” says Andee Bingham, founder and executive director of Esther Neonatal Kitten Alliance in North Carolina. “I prefer tube-feeding if the kitten doesn't want to swallow or is totally refusing to latch. You can feed a kitten in 30 seconds rather than spending 12 minutes and when you’re feeding at 4 a.m., that amount of time is significant.”
So, what about supplies?
Even the most basic program is stocked with the essentials, but should you buy cute stuffed animals, and should they be with or without a ‘heartbeat?’
“Anybody who has seen a tiny kitten cuddle with a stuffie knows there must be value in that,” Erin says. Though she has not seen data on whether they reduce disease or mortality, her anecdotal experience is enough to recommend stuffies.
“I’ve had a positive experience with them in my own home, especially for singletons,” she says. “They’re relatively inexpensive and you can put them on your Amazon wish list or social media. When I see videos of little kittens purring with a mom stuffie who has a heartbeat, it warms my soul.”
On the high-tech end, incubators are starting to pop up more frequently in kitten nurseries, though the experts think organizations should only consider them if it won’t cut into purchasing essentials. Hannah Shaw, “Kitten Lady” and founder of Orphan Kitten Club, talks about incubators as well as other heat sources on her website.
“If you’re caring for a lot of kittens under three weeks old and it's in your budget, incubators are a fantastic option,” she says. “But the difference between a kitten raised in an incubator versus one raised with another heat source is not enough to warrant spending the money - if it means reducing your budget for other lifesaving tools like diagnostic testing.”
And they can be pricey, running from several hundreds of dollars up to around $1,500.
“They aren’t something everybody can invest in, but they are good for preemies or babies who come to us ice-cold,” says Andee. “Without being able to warm them quickly in a 100° incubator, we wouldn’t be able to save them.”
Requiring extensive testing is a fast way to drain your program’s bank account, though cost is just one reason FIV/FeLV tests are beginning to be discarded by shelters. Some organizations have begun spending a portion of their budget on something that may have greater lifesaving impact: fecal testing for kittens with unresolving diarrhea.
“Diarrhea is a major cause of suffering, sickness and deaths in kittens,” Hannah says. “When you're guessing which treatment is appropriate, you're wasting time and resources. Instead, you should determine what the cause is and treat for it.”
That being said, all four experts treat every kitten prophylactically for roundworms and other common parasites, and Kitten Alliance regularly consults the National Kitten Coalition’s “Kitten Stool Chart” for guidance, However, they also received a microscope from a donor so they can do fecal exams in-house. Andee says it’s a valuable alternative to paying outside vets and waiting several days for results.
“When you're talking about fragile kittens, whatever is causing their diarrhea could kill them in that time,” she says. “For us, this has been really game-changing.”
For Heather, although there is value to fecal testing, she stresses that it should not be the first use of your limited dollars.
“If a kitten fails to respond to treatment for common parasites, probiotics, a bland diet or a GI diet, and B-vitamins, then I will spend the money for a fecal PCR,” she says. “But there's significant evidence that fecal tests don't reveal the cause of diarrhea. Even if coccidia, Giardia, tapeworms or other parasites are present, those things by themselves may not be the cause.”
“It’s an expense, but to me it’s a priority that warrants spending money on when the issue is not getting better after treating for common parasites,” Hannah says.
Welcome to the fungal jungle
There probably isn’t a shelter or rescue person alive who hasn’t experienced the joy of bathing ringworm animals in stinky lime sulfur dip; Hannah’s first time almost put a stop to fostering such kitties.
“My first ringworm cats were a mom with six or seven babies,” she recalls. “I remember thinking, ‘What have I gotten myself into?’ I didn't want to foster ringworm kittens again after that.”
Luckily, there are new treatments for treating ringworm. KCPP ceased using lime sulfur baths altogether and relies instead on oral itraconazole (Itrafungol), which is part of a protocol being studied by Karen Vernau, DVM, of University of California Davis.
“Itraconazole (Itrafungol) is expensive, but it’s more efficient and effective,” Heather says. “Our ringworm typically resolves in two to four weeks.”
Orphan Kitten Club, which is a co-sponsor of the UC Davis study, opts for topical miconazole and baths with KetoHex shampoo.
“You wash out the shampoo, unlike lime sulfur dip, which damages the skin,” Hannah says. “We also use supplements like fish or vitamin E oil as a supportive measure.”
Whichever route you choose, there are alternatives to what the industry has been doing for a long time.
“Do some research,” Hannah says. “I think with alternatives you might get more people wanting to foster ringworm kittens, too, because they won’t smell like rotten eggs.”
Are necropsies necessary?
Although it’s certainly not the most pleasant component of a kitten program, Heather and Hannah strongly believe that organizations that can afford them should consider doing necropsies.
“People assume that a certain number of kittens will experience ‘failure to thrive’ or ‘fading kitten syndrome’,” Hannah says. “These are terms we use when we don't know why the kitten died, but there’s always a reason. Knowing what it is can change your protocols for the better. For instance, we don’t lose that many kids, but in those we do lose we see a lot of GI issues. Now we give every kitten probiotics.”
A necropsy also saved the life of a very special kitten named Ferguson. When his littermate passed away, a necropsy revealed died from a kidney infection. A subsequent visit to a nephrologist for Ferguson revealed that he had kidney disease, too.
“We wouldn’t have known to intervene without those results,” says Hannah, who has since adopted Ferguson. “His kidney disease required special care, and although he was only expected to live for eight weeks, he’s nine months old now.”
“Unless I am swamped, I necropsy every kitten that dies in our care,” Heather says. “Necropsies can also be valuable for foster programs because foster parents really want to know that they didn't cause the kitten to die.
As with all the above suggestions, Hannah stresses that there is “what's possible and there is what's practical.
“For some organizations those are not going to align, but we should all strive for what is possible,” she says. “I imagine a day when everyone can afford all that is possible—and with each change, we are encouraging ourselves to move one step closer to that each day.”
Next week, in part two of Kittens 2.0, Hannah, Heather, Andee and Erin will share their insights about operational issues related to kitten programming.
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