ABSTRACT: There is a wealth of information available in textbooks, scientific publications and conference proceedings, as well as advice from veterinarians and anecdotal personal experience regarding the care of neonatal puppies. Neonatal survival in domestic dogs can be improved by effective management of the bitch and appropriate neonatal care. This article aims to bring this information together to provide the veterinary nurse with a useful and informative reference guide for the practice file.

Part one of this two-part article covering care of the neonatal puppy will describe the healthy neonate – how to identify whether a puppy is healthy, how to care for the healthy puppy including the period immediately after birth, resuscitation, common congenital defects and how to artificially rear a healthy puppy.

Next month, part two will consider the sick neonate and describe the different conditions to which neonates are susceptible, including hypothermia, hypoxia, dehydration and hypoglycaemia.The article will include how to recognise the signs of disease and the treatments recommended.


During the neonatal period, puppies have immature physiological responses when compared with adults; they have limited ability to regulate or control body temperature, fluid balance or energy levels, their immune system is not completely developed and they may display irregular respiratory patterns.14 These factors affect their susceptibility and response to disease.

The variable and relatively high rates of neonatal loss reported in domestic dogs (10-30%) can be improved by effective management of the parturient bitch and appropriate neonatal care.1'2-5’7 The neonatal period normally refers to the first week to 10 days after birth and although puppies remain at risk during the first three weeks of life, mortality is reported to be greatest during die first week.1-2-8-9

This article will enable the veterinary nurse to identify a healthy neonatal puppy and provide the breeder with information on the optimal care of neonatal puppies in the first weeks of life.

The healthy neonatal puppy

A normal, healthy neonatal puppy should have a rounded and full abdomen, and skin that is warm and elastic.10 Puppies should suck enthusiastically for a short period approximately every two to three hours for the first few days. "-12 Birth weight should increase by five to 10 per cent per day 11 and neonates should weigh double their birth weight by day 10-12.10-12

Body weight is an important indicator of neonatal health and pups of low birth weight may be at increased risk of hypothermia, hypoxia and infection (Figure 1). Weight gain very early after birth has been linked to survival13 and daily weight gain should be monitored to allow quick identification of any puppies who are not gaining, or who are losing, weight.12

Figure 1: A two-week-old puppy being weighed to monitor weight gain

Puppies should be able to lift their heads at three days of age and crawl at seven days, but will be unable to stand until approximately the end of the third week.10’12 Puppies will spend approximately 80 per cent of their time sleeping12 with an activated sleep pattern (twitching movements when asleep) and only cry when hungry or disturbed.1'10

There is variation in the reported correct body temperature for a neonatal puppy, although body temperature is known to decline immediately after birth and then recover4'11 (Figure 2 & Table 1).

Figure 2: Normal changes in rectal temperature for puppies in the five hours immediately following birth (Gary England, unpublished observations!

Respiration and heart rates for neonatal puppies are reported to be irregular at birth (10 to 20 breaths per minute and 150 to 220 beats per minute respectively) and then stabilise during the first seven days of life (15 to 40 breaths per minute and 200 to 220 beats per minute).1-1112 Generally smaller breeds are at the higher end of the'range for both respiratory rate and heart rate.

At birth, puppies’ eyes and external ear canals are closed. The eyes begin to open at 10-14 days and the external ear canal at 14-16 days, with cells sloughing off from the ear canal for one week after the canal opens.10-12 No discharge should be present from the ears, eyes or nose.11

Care of the neonate after parturition

Immediately after parturition, the dam should sever the umbilical cord and lick the puppy to remove the foetal membranes (Figure 3). This encourages respiration and warms and dries the pup. The bitch should then incite the pup to move to the teat and suck.11 Assistance maybe necessary where the dam does not – or can not – exhibit these behaviours.11

Figure 3: A bitch licking a newborn pup whilst the first born has moved to the teat and started to suck

The foetal membranes must be removed and fluid cleared from the mouth and nose using a dry towel, bulb syringe or pipette to prevent prolonging hypoxia.1'11-15 Fluid can be encouraged to drain away from the respiratory tract by holding the puppy cupped in the hand with the head tilted downward and hindquarters elevated whilst supporting the head and neck. Rocking the puppy backwards and forwards in an arc can also help release fluid from the respiratory tract.11

It is important that puppies are not subject to swinging to clear the airways owing to the risk of cerebral injury.1-3-15 Pups can be rubbed gently but briskly for around 30 seconds with a warm dry towel to help stimulate breathing and to warm and dry the pup.311-14 When breathing is <10 breaths per minute or when there is no movement or crying, and when heart rate is low, intervention may be required to attempt to resuscitate the neonate.

Provision of oxygen, rubbing and warmth along with gentle chest compressions and medication can be used to resuscitate neonatal puppies (Figure 4). Resuscitation should not be attempted in circumstances where the pup has died some time ago in utero.

Figure 4: Diagnostic plan for neonatal resuscitation [adapted from Traas, 2008 ]

After the pup has been delivered, the umbilical cord can be clamped with forceps or ligated approximately 1cm from the abdomen and torn or cut a further 1cm along.15-17 The stump should then be treated to prevent infection – tincture of iodin
e and diluted chlorhexidine solution are reported as being suitable 1, 2-15 The treatment should be non-toxic in case it is ingested by the dam when she cleans the puppy.12

Once the puppies are stabilised they should be sexed, weighed and checked for congenital abnormalities such as anal atresia, limb deformities, cleft palate and harelip, which can affect between one and 15 per cent of newborn puppies, depending on the breed.10'12-15 They can then be placed in an incubator or pre warmed box and can be returned to the dam when they are active (Figure 5).

Figure 5: Newborn puppies huddling in an incubator

Puppies are born wet into an environment that is cooler than maternal body temperature, which further increases the risk of hypothermia. It is, therefore, important that parturition occurs in a warm and dry, draught- and damp-proof room which can be heated.1’18

The risk of hypothermia can be reduced by:

   ensuring adequate energy intake;

   providing a proper nest area;

   encouraging huddling; and

   providing external heat sources, although care must be taken to avoid overheating.

Infrared lamps are the recommended heat source for the nest area because, unlike hot water bottles and heat pads, there is no risk of burning owing to contact with the skin. A cooler area should also be accessible to both the dam and puppies to prevent over-heating.15 The ideal environmental temperature for the nest and surrounding area varies between reports and temperature should be monitored by placing a thermometer directly in the whelping box (Table 2).15

The decreased placental blood supply that occurs during the process of birth commonly causes puppies to be born with mild acidosis and hypoxia, although within two to four hours after birth, a normal healthy neonate will recover from the effects.12'14 Higher mortality rates may occur if the period of hypoxia is extended, for example in cases of Caesarean births, poor maternal care and dystocia. Intervention may be necessary when blood oxygen concentrations remain below normal when the neonate is four hours old.12

Once parturition is complete, the dam should rest and allow the pups to suck (Figure 6). Puppies are born with low glycogen reserves and poor body fat reserves with little ability to generate energy and so they can be predisposed to hypoglycaemia in the first 15 days of life.12-15 The first milk, called colostrum, boosts the pups’ immune system by passive transfer of immunity from the dam.19 This should be ingested within the first 24 hours, because after that time the ability to absorb intact proteins through the gut wall decreases.12-19

Figure 6: A bitch resting once the whelping is over, allowing the pups to suck

Ensuring that puppies suck soon after birth can help prevent hypoglycaemia, especially following hypothermia or hypoxia. The availability of teats, poor milk production, an inexperienced, difficult or sick dam, weak pups or continual disturbance by humans can all affect food intake. Alternative sources of colostrums, including commercially available products, should be provided in these cases (see later section on artificial rearing).

Until puppies are approximately three weeks old, there is no voluntary control over the opening of the bladder or bowels, and the dam encourages urination and defecation by licking the perineal region.11 The bedding in the whelping area should be changed regularly so that the dam and puppies are not resting on dirty bedding.

A programme of preventive healthcare should include:

   immunisation of bitches with appropriate vaccines (canine distemper, parvovirus, adenovirus type II and parainfluenza) prior to breeding;

   where necessary, immunisation of pregnant bitches to provide passive immunity against canine herpes virus; and

   a de-worming schedule for pups starting at three weeks of age, and repeated two weeks later with a non toxic anthelmintic, such as pyrantel pamoate (5mg/kg PO).1

Monitoring of faecal egg counts may be advised to help decrease neonatal losses.

Artificial rearing

Artificial rearing should only be undertaken once all other possibilities, including fostering on to another dam, have been considered.15 Puppies in large litters may be rotated between artificial rearing and being reared by the dam, allowing them to stay in the nest which will allow adequate socialisation.

In cases where the dam dies during birth, colostrum can normally be expressed within 15 minutes of death (this should be avoided when toxins or drugs may be present). For bitches that die under anaesthesia, the induction agent will have been metabolised/redistributed by the dam and volatile agents do not pass into milk; however, both opioids and non steroidal anti-inflammatories used as pre- meds may pass into the colostrums, but at doses so low as to have negligible affect.

Alternatively, canine colostrum from a commercially available or frozen source should be administered. Less satisfactory is providing colostrum from a different species (here antibody protection will be limited); furthermore provision of food as milk from another species on a long-term basis is not advised.15

Commercially available milk replacements are advised when the mothers milk is inadequate or unavailable and should be fed at 37-38°C in relation to bodyweight and age. Whilst recipes to modify cow s milk are available, powdered formula bitch milk is more acceptable and less susceptible to bacterial infection.15

The total volume to be fed should be adjusted based on puppy growth20 and be evenly divided across feedings – given every three hours in the first week with the interval gradually increased to every six to eight hours by four weeks of age (Table 3).

If puppies will not suck, then milk can be administered via an orogastric tube or feeding bottle15 (Part 2 of the article will deal with tube feeding).

Solid foods can be introduced starting at three weeks of age by mixing a good quality complete puppy food with the milk formula and offering in small amounts four times a day. This can be gradually thickened until no milk substitute is used at about six weeks of age.

Care should be taken that the puppy is not inhaling food (rather than swallowing it) and that overfeeding is prevented. When neonates are being reared artificially, urination and defecation must be initiated after e
very meal by stimulating the perineal region with dampened, warm cotton wool.15 The urine produced by well- hydrated puppies should be colourless.


It is important that the signs of a healthy neonate are well recognised and that those who supervise a whelping are aware of the management and husbandry skills required to provide the best possible care and support. 


Rachel Moxon BSc(Hons)

Rachel graduated from the Nottingham Trent University with a Degree in Animal Science. Since then she has worked in equine nutrition and exercise physiology research in Kentucky. USA, before joining Guide Dogs |UK| as a canine research associate focusing on reproduction, based at the Guide Dogs National Breeding Centre in Warwickshire.

Gary England


Gary graduated from the Royal Veterinary College in 1986. He has British, European and American specialist qualifications in animal reproduction and is Professor of Comparative Veterinary Reproduction at the School of Veterinary Medicine and Science, University of Nottingham.

To cite this article use either

DOI: 10.1111/j.2045-0648.2011.00132.x or Veterinary Nursing Journal Vol 27 pp 10-13


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• VOL 27 • January 2012 • Veterinary Nursing Journal