Management and Diseases of Neonatal Camelids in the Early Post-Partum Period
Erica C. McKenzie, BSc, BVMS, PhD, DACVIM
Management of neonatal crias in the immediate post-partum period should involve careful observation combined with minimal unnecessary handling, particularly when dealing with primiparous dams, to avoid disruption of maternal bonding. However, it is important to rule out obvious congenital defects, and to intervene if problems become apparent in the dam or neonate.
Gestation and Parturition in South American Camelids
Gestation length ranges from 335 to 360 days (mean ~ 340 days) and is longer in llamas than alpacas.1 Gestation of less than 325 days produces a cria which should be considered premature. Parturition occurs in daylight in the vast majority of animals. Delivery in the late afternoon or nighttime should be regarded with suspicion and every attempt made to attend the delivery, with careful examination of the dam and cria for problems including prolonged dystocia from unrecognized labor.1 However, dams may also delay parturition when disturbed by handling and activity, therefore the delivery area should be quiet and free of stressors. Obvious udder development and perineal and vulval swelling are uncommon indicators of impending parturition in camelids and should not be expected.
Parturition is usually rapid and uncomplicated. Stage 1 labor, consisting of fetal repositioning and cervical dilation lasts 2 to 6 hours. Signs of Stage 1 labor are often subtle and easily missed without close observation, and may include anxiety, frequent urination and defecation, vocalization and restlessness. Delivery should be complete in 8 to 25 minutes, and should not last beyond 30 minutes without examination or assistance, although delivery may be longer in primiparous females. Crias usually present in a cranial dorso-sacral position with the head lying on top of the legs, but occasionally the legs may be positioned over the head. A caudal dorso-sacral presentation with the hindlimbs protruding first may also be considered a normal presentation, but occurs much less commonly, and caudal presentation may result in dystocia.1,2 Dams frequently deliver the cria from a standing position. Camelids have a diffuse epitheliochorial placenta with an extra fetal membrane of fetal epidermal origin. This thin, white covering attaches to the neonate at mucocutaneous junctions, the coronet of the nails and the umbilicus.3 The remaining placenta should be delivered rapidly (no later than 2 to 6 hours) and should be examined to ensure it is complete with both horns intact (the left horn is the pregnant horn in 95-98% of births). Placental retention is rare but if the placenta is retained to 24 hours, oxytocin (20 to 30 units IM) may be given.
Management of the Healthy Neonate
Normal crias are alert and quickly attain and remain in sternal recumbency. A brief period of open mouth breathing may occur but should not be accompanied by audible stertor, stridor or distress. Crias are obligate nasal breathers so ensure the epidermal membrane is cleared away from the nostrils and the nasal cavities are clear. Cria body temperature reflects the dams at birth (100 to 102°F) and subsequently may range up to 102.5°F. Cria heart rate is 60 to 100 beats per minute (often exceeding 80 beats per minute) and the normal respiratory rate is 10 to 30 breaths per minute but potentially may exceed this range for the first hour.2
Healthy crias usually stand and nurse within 1-2 hours, which can be assisted by stripping the wax plugs from the teats of the dam. Nursing is more frequent (1-4 times an hour) during daylight hours and may last from 30 seconds to several minutes at a time.1 Meconium is often not passed until 18 to 24 hours after birth. An enema of warm soapy water using a flexible small diameter catheter can be given if straining is observed. Normal crias have a high urine output and therefore urination is observed frequently. Prolonged positioning and mild straining with urination has been observed in apparently healthy crias for periods of several days after birth, but it is possible this represents irritation of the urachus or bladder. The umbilicus should be dipped with dilute chlorhexidine (1:3 ratio or 0.5%) three times daily for 48 to 72 hours. In selenium deficient areas crias should receive Bo-Se® (0.5 cc for alpaca cria, 1 cc for llama cria) and vitamin D administration (1500-2000 IU/kg) should be considered, particularly for dark-coated fall born crias.4
Several factors immediately place a cria into the high-risk neonate category. These include birth following dystocia or correction of uterine torsion in the dam, prematurity, excessive umbilical hemorrhage, low birth weight, and congenital defects that impede ambulation, respiration or cardiovascular function, or result in dystocia. In the absence of congenital malformations, dystocia often results from 'elbow or shoulder lock' or caudal malpositioning of one forelimb, which are usually readily correctable situations. However, since there is only a small amount of amniotic fluid associated with the camelid placenta, prolonged delivery can result in drying, and generous lubrication should be utilized in correcting dystocias.2
The umbilical cord usually ruptures several inches from the body. Crias have been suggested to be more prone to umbilical hemorrhage than comparable species. However, if necessary, ligation of the umbilicus should be transient (1-2 hour's duration) and performed several inches from the body wall, to avoid infection, tissue necrosis, and development of a patent urachus. Additionally the cria should be monitored for signs of internal hemorrhage (weakness, tachycardia, decreasing total protein and PCV) as internal umbilical hemorrhage has resulted in fatal hemoabdomen. Investigation of umbilical abnormalities should include ultrasound investigation of the abdominal cavity and the urachus, bladder, and umbilical arteries (2) and veins (2).1
If a cria does not commence breathing at birth, mouth-to-nostril resuscitation is indicated as an emergency measure, but ideally one should be prepared with emergency drugs and supplies at the delivery and in such cases, endotracheal intubation can be performed blindly or with a long laryngoscope. A size 4 endotracheal tube is usually suitable, and air can be delivered by mouth to tube methods, or preferably via ambu bag or oxygen demand valve if available. A small catheter (10-12 French) can be inserted up the nostril to the level of the medial canthus and oxygen supplied at a rate of 2-4 L per hour. If resuscitation or other interventions are required, emergency drug administration may include atropine (0.04 mg/kg IV), doxapram (0.1 mg/kg IV) and epinephrine (0.01 mg/kg IV).
Failure of Passive Transfer and Hypogalactia
Intervention is indicated if a cria has not nursed successfully within 4 to 6 hours of birth. Crias are agammaglobulinemic at birth, and capable of absorbing ingested globulins for up to 16 to 24 hours.5,6 Serum IgG concentration can reach up to 2500 mg/dl 24 to 48 hours after nursing and will slowly decline after about 10 days to a nadir of ~500 to 700 mg/dl by 3 to 6 months of age. However, serum IgG in healthy animals should not decline below 500 mg/dl any time after birth. Mature serum IgG concentrations, attained by 4 years of age, approximate 2000 mg/dl.
Determining passive transfer can be based on several approaches. Observation of normal nursing behavior is often used, although there is still a risk of failure of passive transfer (FPT), particularly in primiparous dams in which colostrum quality or production may be poor. Serum total protein concentrations < 4.5 mg/dl are strongly suggestive of FPT; concentrations of 4.5-5.5 mg/dl are equivocal and may reflect inadequate passive transfer; and concentrations exceeding 5.5 mg/dl are likely associated with successful passive transfer.7,8 Evaluation of serum gammaglutamyltransferase activity is an unreliable predictor of passive transfer.9 Serum IgG can be quantified by sodium sulfite immunoglobulin precipitation (llama S test) which provides immediate results. Radial immunodiffusion provides the most accurate quantification of serum IgG and at least two kits are commercially available for camelids.7,10 However, final results are not obtained for 20 to 24 hours, although some idea of the final outcome may be apparent by 12 hours. Operators should be aware that there are substantial differences between different manufacturers' RID kits in terms of the absolute values and reference ranges provided, and that these kits will not detect immunoglobulin from other species if using substitute ruminant colostrum sources.10 A serum IgG concentration of 800 mg/dl is often used as an indication of adequate passive transfer, but it should be recognized that healthy crias frequently have substantially higher concentrations depending on the RID kit used.5,6,8
Inadequate nursing behavior (or orphaning) mandates supplemental feeding of colostrum ideally no later than 6 hours after birth. Attempts to strip colostrum from a camelid dam are usually met with much resentment and likely failure. Goat colostrum is an ideal alternative, but cow colostrum can also be used since the protein and fat content of goat and cow colostrum approximates that of camelids (sheep colostrum has too high a fat content). Substitute colostrum should be obtained only from Johne's free properties. Crias should ideally receive 8-10% of bodyweight in colostrum in divided feedings over the first 18 hours of life.1
Bottle feeding (from a small nipple with a cross cut) is ideal since it stimulates closure of the esophageal groove with shunting of fluid past C1. However, bottle feeding should not be continued in orphans beyond the first day to avoid imprinting and future problems such as 'berserk male' syndrome, and orphans can either be trained to a pan or tube fed three to four times daily. Ideally supplemental feeding for orphans should be performed out to two months of age or longer if possible, although creep feed consumption can commence as early as one week of age. If tube feeding is performed the tube can be placed to the level of the thoracic inlet in an attempt (unlikely successful) to shunt the fluid through C1 in the esophageal groove. Body temperature should be at least 98F for weak crias to be tube fed, to avoid the fluid sitting stagnant in the first compartment. An indwelling feeding tube (12-14 French) can be sutured to the nostril of weak neonates to allow periodic feeding of small volumes.
Crias require 10 to 12% of their bodyweight in milk per day and can receive as much as 3.5% in one feeding although smaller volumes in six feedings per day may be tolerated better.11 Bottle feeding crias can be given as much as they will voluntarily consume in one feeding. Feeding frequency can be decreased as the cria grows. Goat or cow milk, or goat kid milk replacer (non-medicated) can be utilized. Cow and goat milk tend to be lower in energy content than camelid milk. The addition of goat yoghurt to kid milk replacer at a 1:3 volume ratio has been suggested to compensate for this shortfall. Weak or premature crias may be better receiving partial requirements in milk (3% bodyweight) with the remaining requirements met with partial parenteral nutrition (amino acids and dextrose). Healthy crias have been estimated to require approximately 50 kcal/kg/day, including 3 g/kg of protein and 80 ml/kg of water. Sick or septic crias may require three times this amount of energy (150 kcal/kg bodyweight per day).
Assessing lactation failure and subsequent malnutrition in the cria can be difficult. Inadequate lactation is probably common in primiparous females, and may affect more than 5% of dams.1 Inadequate lactation may also occur with premature parturition.
Successful nursing may be indicated by milk around the cria's mouth, a cria that routinely lies down and sleeps after nursing, and appropriate nursing behavior (1-2 times an hour). Crias should also be monitored for adequate weight gain (0.5-1 lb/day for llama crias; 0.25-0.5 lb/day for alpaca crias throughout the first 2 to 3 months of life). However, weight gain usually does not commence until day 3 after birth. Signs of inadequate nutrition in crias include weakness, frequent nursing, attempts to nurse other dams, constant nibbling on forage or the dam's fiber, and inadequate weight gain. Supplementation may be needed if crias have not gained weight by day 3 or are losing weight on day 2 and appear lethargic. Domperidone (Equidone® oral gel) has been recommended for treating agalactia in camelids by giving three times the equine dose orally (~5 cc for a llama) for 7-10 days. Improvement in milk production may be noted in the second week of treatment. However, supplemental feeding should be continued during this time, and the cria carefully monitored for weight gain and appropriate behavior once the treatment is thought to have worked.
If FPT has occurred and the cria is beyond 16 hours of age, alpaca or llama plasma should be administered. Otherwise the cria should be maintained in a clean environment with umbilical dipping and prophylactic antibiotic therapy. Crias should receive 20-40 ml/kg of plasma intravenously. Intraperitoneal administration of plasma is commonly practiced, whereby warmed plasma is administered over 5 to 10 minutes through a teat cannula placed into the abdominal cavity through an aseptically prepared midline stab incision. However, immunoglobulin absorption via this method is unknown (assumed to be ~70%) and transient signs of abdominal distress may occur. Whole blood (500 ml over 2-3 hours) can also be administered if plasma is not available. Often one unit of plasma (~300 cc) is administered to alpaca crias and two units to llama crias, however it has been demonstrated that serum IgG concentrations in crias following plasma administration can be highly variable and do not necessarily correlate well to the volume of plasma administered and reevaluation of serum IgG might be prudent.
Prematurity can be difficult to identify since gestation length is variable and breeding dates not necessarily be correctly recorded. However, crias with a gestation of less than 325 days should be considered premature, and dysmature crias (acceptable gestation length with aspects of prematurity) are also reported. Signs of prematurity include floppy or tipped ears, less than four erupted incisor teeth (all six are present in full term crias), low birthweight (< 9 kg llama cria, < 5.5 kg alpaca cria), weakness, overextension of the fetlocks and a silky coat.2 In crias more than a month premature the eyelids may be closed. Additionally the epidermal membrane is thicker and may persist for 24 hours and the toenail coverings may persist for 24 to 48 hours versus 6 to 12 hours in non-premature crias. Premature crias may have respiratory acidosis, persistent hypoglycemia and neutropenia in addition to sub-optimal intestinal immunoglobulin absorption. Plasma transfusion to prevent FPT is commonly required.
Multiple congenital defects have been reported including arthrogryposis, syndactyly, polydactyly, cardiac defects, tail defects, atresia ani and a variety of craniofacial defects.2 Choanal atresia is one of the more serious and prevalent craniofacial defects. Membranous or osseous separation of the nasal and pharyngeal cavities occurs at the level of the medial canthus of the eye on one or both sides of the head. The separation can be partial or complete. Other facial deformities including shortened nasal bones or abnormally narrow nasal cavities may occur concurrently. Since crias are obligate nasal breathers, complete bilateral atresia can be fatal due to asphyxiation, or result in starvation and/or aspiration pneumonia. Less severe cases may become evident under stress or are undetected until later in life. Affected crias display dyspnea with extension of the head and neck, open mouth breathing and puffing of the cheeks. Nasal flare is unreliable since it is present in normal crias. Diagnosis involves appreciating reduced airflow through one or both nostrils, and contrast radiography whereby 5 to 10 cc of contrast agent (hypaque or barium sulfate) is instilled into each nasal cavity in turn and lateral and dorsoventral views obtained. Endoscopy may be superior for detecting partial chonal atresia but tracheostomy may be necessary to facilitate these diagnostic procedures. Computed tomography would be the ideal and least invasive diagnostic method where available. Since there is a possible hereditary component to this condition ideally the dam and sire should be removed from the breeding line.
Congenital cardiac defects also occur at a significant rate in camelids and include ventricular septal defects, vascular ring anomalies, patent ductus, tetralogy and transposition of the great vessels among others. It is important to identify cardiac defects promptly for the owner's benefit since weak, affected crias may incur great expense during treatment for presumed sepsis or other problems. Less severe defects such as VSD may result in murmurs with few clinical signs. However, crias with severe cardiac defects are often weak, and persistent hypothermia of several days' duration has been a feature in several such crias the author has seen. A key feature is often dramatic hypoxemia (PaO2 12 to 14 mm Hg) and no change in hypoxia after oxygen administration. Such a finding should prompt immediate echocardiography to confirm and identify the abnormality, and affected crias should be euthanized.
Medical Management of Weak/Septic Crias
If possible a full complement of blood analyses should be performed including blood culture, CBC, biochemistry, arterial blood gas analysis and serum IgG measurement to identify relevant problems including sepsis, acidosis, FPT, hypoxia, hypoglycemia, hyperlactatemia, azotemia, hepatic lipidosis and anemia. Arterial blood samples are most readily obtained from the femoral artery. Venous blood should be obtained after placement of a jugular catheter to avoid damage to the vein and subsequent difficulty placing the intravenous catheter. Suitable catheters for jugular placement in small crias include an 18 G 1.5 inch 'dog' catheter and a 16 gauge over the wire catheter. The latter may be more readily placed with the cria positioned in sternal recumbency. If jugular catheterization is unsuccessful, a 20 G one inch catheter can be placed in the brachial vein. Additionally, intraosseous infusion sets (Vidacare EZ-I® 15G) are available and many substances are safe for administration via the intraosseous route. Broad spectrum antibiotic therapy is often indicated, particularly with CBC abnormalities. Ceftiofur, or penicillin combined with an aminoglycoside are often used. Renal toxicity is possible and aminoglycoside therapy may best be accompanied by intravenous fluid therapy and monitoring of renal variables in dehydrated crias. Antibiotic sensitivity testing should be performed on any blood culture isolates since gram-negative bacteria are often involved in sepsis although gram-positive organisms including Streptococcus and Listeria may also occur.12,13 NSAID's should be used judiciously and only when considered absolutely necessary.
IV fluid therapy is frequently indicated in sick neonates, particularly those that are azotemic or cannot meet their fluid and energy requirements through oral nutrition. Neonatal fluid requirements are comparable to other neonatal herbivores at 120 ml/kg/day.11 However, crias appear to be susceptible to complications with fluid overload including pulmonary and cerebral edema, and therefore fluid administration should be performed carefully with frequent adjustment, and oral nutrition should be accounted for in fluid rate calculations. Administration should be performed using a fluid pump, or alternatively, boluses may be given every 3 to 4 hours. Crias are also susceptible to hepatic lipidosis which may be reflected by serum hepatocellular enzyme derangements and elevations in betahydroxybutyrate and non-esterified fatty acids. Therefore partial parenteral nutrition (PPN) is commonly indicated and a mix of amino acids and dextrose in polyionic fluids is frequently given, with or without insulin (0.4 IU/kg SQ) depending on the degree of metabolic derangement. During PPN therapy, blood glucose should be monitored periodically to avoid glucose diuresis and hypernatremia. Crias that are very hypernatremic can be fed half strength milk replacer to avoid further sodium loading. When ceasing PPN therapy, the administration rate should be decreased over 24 to 48 hours with no insulin administered for at least 24 hours before ceasing.
Well managed farms should aim for cria losses of < 5% per year. Intensive monitoring can help address problems early in the post partum period. Additionally ensure the dam is vaccinated and dewormed 2 months prior to parturition to avoid stress in late gestation.
1. Fowler M. Medicine and Surgery of South American Camelids. Ames, Iowa State University Press, 1998.
2. Paul-Murphy J. Vet Clin North Am: Food Anim Pract 1989;5:183.
3. Musa BE. Zbl Vet Med C Anat Histol Embryol 1977;6:355.
4. Smith BB, Van Saun RJ. Am J Vet Res 2001;62:1187.
5. Garmendia AE, McGuire TC. Am J Vet Res. 1987;48:1465.
6. Weaver DM, Tyler JW, Scott MA, et al. Am J Vet Res. 2000;61:738.
7. Drew ML, Fowler ME. J Am Vet Med Assoc 1995;206:1374-80.
8. Weaver DM, Tyler JW, Marion RS, et al. J Am Vet Med Assoc 2000;216:559.
9. Johnston NA, Parish SM, Tyler JW, et al. J Am Vet Med Assoc 1997;211:1165.
10. Garry F, Weiser M, Belknap E. Vet Clin North Am: Food Anim Pract 1994;10:201.
11. Riek A, Gerken M, Moors E. J Dairy Sci 2007;90:867.
12. Adams R, Garry F. J Am Vet Med Assoc 1992;201:1419.
13. Dolente BA, Lindborg S, Palmer JE, et al. J Vet Intern Med 2007;21:519.