Veterinary care should include diagnostic tests to help determine the health of the puppy
and guide subsequent recommendations. Diagnostic tests may include: Physical exam. A thorough physical examination of the puppy, and dam if possible, in the presentation of any "fading puppy." The exam should rule out a cleft palate, cranial deformities, cardiac abnormalities and illnesses. The dam should be examined for adequate (quantity and quality) milk production and infections.
Blood tests. Blood work on neonates is often not done initially because response to immediate treatment is usually positive and it can be difficult obtaining a sufficient amount of blood from a sick neonate. However, if a small amount of blood can be obtained, serum glucose, total protein and blood urea levels can be assessed.
Additional diagnostic tests may be recommended on an individual basis:
A complete blood cell count to evaluate red and white blood cell numbers (to look for signs of infection, anemia and dehydration)
Serum protein levels to provide information concerning the presence or absence of infection, anemia and dehydration
Radiographs to evaluate internal organ or skeletal abnormalities
Serum profile to evaluate internal organ function (liver, kidney, heart)
Body temperature. Raise the body temperature slowly to normal if the puppy is hypothermic. Incubators, hot water bottles and heat lamps can be used to maintain an immediate environmental temperature of 84 to 90 degrees F. Rectal temperature should be taken to monitor body temperature and avoid overheating. Maintaining the humidity around 50% will minimize water loss and dehydration.
Fluid therapy. Administer fluids subcutaneously (under the skin) to correct dehydration. Often it is difficult to catheterize a vein in a dehydrated neonate, so a physiologic replacement fluid can be first given subcutaneously to re-hydrate the puppy. Giving 2-5% of body weight (2 to 5 ml (cc) fluid/100 g BW) may be sufficient to revive the puppy. If not, this dose can be repeated.
Nutrition. To provide nutrition, feed the puppy a warmed milk replacement formula. Feeding puppies raises body temperature and provides fluid and energy substrates for normal metabolism. A cold, comatose puppy should not be tube-fed until corrections of a low body temperature and dehydration have been resolved. Milk will remain in the stomach of cold, comatose puppies. Proper gastrointestinal function requires near-normal body temperature and fluid balance.
These treatments revive most neonates within a few hours. If the puppy is not revived, then additional diagnostics may be performed to determine if the puppy has congenital abnormalities, infections or other illnesses.