- Email: [email protected]
Obstetrics, Neonatal Care, and Congenital Conditions
Llama Medicine
0749-0720/89 $0.00
+ .20
Obstetrics, Neonatal Care, and Congenital Conditions Joanne Paul-Murphy, DVM*
OBSTETRICS Llama gestation has an average length of 335 to 350 days, but has been known to extend beyond 1 year. Most births occur rapidly and, typically, during daylight hours. Knowledge of breeding dates permits early separation of the dam from the herd into a maternity area for close observation of parturition. It is best not to move or disturb a llama after labor has begun unless signs of dystocia are evident because this may prolong the delivery. Signs of approaching parturition in the llama are subtle and may include relaxation of the vulva and slight increase in size of the udder. Multiparous females may display waxing at the tips of the teats. Stages of Labor Normal labor is a continuous process but is divided into three stages for descriptive purposes. Stage 1 is characterized by uterine contractions and dilation of the cervix to allow the fetus to enter the birth canal. Duration of this phase is variable, and there may be no outward signs of uterine contractions. Behavioral changes include restlessness, humming, increased urination, decreased appetite, and segregation from the herd. There is no indication for intervention at this stage, and it is best to allow some privacy to the dam. Second-stage labor begins when the fetus enters the birth canal and initiates active expulsion. Delivery normally occurs within 60 to 90 minutes. Abdominal pressing will be obvious, and the dam may lie down and get up several times. The chorion usually ruptures during this stage, and the amnionic sac may appear at the vulva and rupture as
*Visiting Professor Department of Veterinary Medicine, School of Veterinary Medicine, University of California, Davis, California 95616
Veterinary Clinics o/North America: Food Animal Practice-Vol. 5, No.1, March 1989
183
184
JOANNE PAUL-MURPHY
well. The amount of fluid lost following membrane rupture is reduced relative to other domestic animals. The epidermal membrane, unique to camelids, remains intact until delivery of the fetus. 3 ,10 This thin membrane lies close to the body and attaches at the umbilicus, hoof coronet, anus, genital opening, mouth, and nares. It is rubbed off as the neonate struggles after delivery. Most llamas deliver in a standing position. Normal presentation is cranial, with dorsal-sacral positioning. Both forelimbs appear together at the vulva, and the head emerges either above or below the legs. The dam may rest before expelling the shoulders. The umbilical cord ruptures as the fetus leaves the birth canal. The third stage of parturition is expulsion of the placenta, which usually passes within 45 minutes of delivery of the fetus and should not exceed a few hours. IS Llama placentas, exclusive of the allantoic fluid, weigh between 0.74 and 1.44 kg. 3 Llamas do not eat the placenta, so the birthing area should be inspected to locate the membranes following an unattended birth. Retained Placenta Retained placenta is a rare complication in llamas. Failure to pass the placenta after 6 to 8 hours warrants treatment of the dam. Manual removal is not recommended. Oxytocin and uterine saline lavage help stimulate uterine contractions and release of fetal membranes. If the placenta is retained greater than 24 hours, repeated saline lavages or antibiotic boluses will help prevent metritis. Involution Uterine involution progresses rapidly and returns the uterus to normal size by 21 days.6,16 A small amount of lochia is normal for the first 5 to 7 days. It may be slightly opaque to dark reddish-brown in color. Llamas will rebreed readily after birthing, even on the same day, but rarely conceive. Conception rates are reported to be higher when the female is bred at 2 to 4 weeks postpartum than when rebred at 2 to 3 months. Dystocia The incidence of dystocia in the llama is low (estimated two to five per cent) but all dystocias require assistance because of the long limbs and neck of the fetus. It is important that owners check near term females frequently so that early intervention is possible if a dystocia develops. Dystocia occurs when any stage of parturition is prolonged or interrupted. Assistance is necessary if first-stage labor exceeds 6 hours without initiating abdominal contractions, or second-stage labor extends beyond 2 hours without signs of progression. In primiparous females, dystocia usually is related to disproportion between fetal size and pelvic dimensions of the dam. Most llama dystocias are caused by fetal abnormalities in presentation, position, posture, or, less frequently, teratogenic defects. Dystocia examination is accomplished best with the animal stand-
185
OBSTETRICS, NEONATAL CARE AND CONGENITAL CONDITIONS
ing and properly restrained. The tail should be wrapped and tied to the side. While preparing and cleaning the perineal region, a history should be obtained from the caretaker regarding gestation length, duration of labor, and degree of prior intervention. With disinfected and lubricated arms, examine the birth canal for cervical dilation, strictures, and size of pelvic region. Examine the birth canal carefully for tears if it has been examined previously. Determine whether the fetus is alive or dead because this affects the course of management. A live fetus will respond to pinching between the toes, pushing gently on the eyes, gently pulling the tongue or inserting a finger in the rectum. If response is uncertain, try to palpate a pulse at the umbilicus. Manual dilation of the birth canal may be necessary. In small llamas and alpacas only one hand may fit into the vagina initially. Using abundant lubrication, insert the hand with palm outwards and press against the vaginal wall while moving around the perimeter. Traction should be applied to the fetus only after the birth canal is dilated. Shoulder lock is the most frequent problem with maternal: fetal disproportion. Rotation of the fetus 45 to 90 degrees will align the greatest width of the shoulders to the maximum dimension of the maternal pelvis (Fig. 1). This must be done before the shoulders engage in the pelvis, otherwise the fetus needs to be repelled and rotated. Apply traction along the longitudinal axis of the fetus. Traction on the legs should alternate between forelimbs so the shoulders pass through the pelvis separately. If both shoulders cannot be delivered, try manipulating the fetus with the dam in lateral recumbency and if this is unsuccessful, a cesarean section should be considered.
A. 5.25" B. 5.75" C.6.0"
Figure 1.
Shape and dimensions of the average female llama pelvis.
186
JOANNE PAUL-MURPHY
Locking at the hips is much less common. It usually can be corrected by placing the dam in lateral recumbancy, repelling the fetus, rotating it 45 degrees, then applying traction by pulling the fetus across the dam's flank. This angles the fetal hips across the widest pelvic dimension. The nostrils and mouth should be cleared and respiration stimulated prior to hiplock manipulations. Cranial presentation also can present with postural deviations of the head and limbs. The manipulations to correct forelimb retentions (flexed shoulder or flexed elbow) are similar to those used to correct similar malpostures in the equine. Deviations of the head and neck are difficult to correct because of the long, thin neck of the fetus. Flexion of the neck backwards or to the right or left side of the fetus is common. Forelimb retention may occur in association with this posture, which can lock the fetal thorax in the pelvic region. If only one arm can enter the birth canal, a snare can be looped around the head or lower jaw. The chest must be repelled while traction is used to pull the head into proper position. This may deliver the head upside-down, necessitating rotation to the upright position within the birth canal. If no progress can be made to straighten the neck, the fetus should be palpated carefully for possible torticollis. Caudal and breech presentations are serious dystocias. These presentations result in prolonged pressure on the umbilicus as it passes through the pelvis. Manual dilation of the birth canal often is necessary. Traction is applied only when the dam pushes, to avoid early rupture of the umbilicus. Cesarean section should be considered if extraction is difficult and extends beyond 15 minutes. When palpation reveals an upside-down fetus, it should be kept in mind that uterine torsion occurs more frequently than this malposition. In uterine torsion, the cervix often is partially dilated. Palpate the birth canal for spiral folds. Rectal palpation is necessary to feel the broad ligament and determine direction of torsion. Most cases are twisted 180 degrees or less. Rolling the dam with pressure applied across the abdomen, using a plank, is the least traumatic technique for correction. If the cervix is open, grasp the legs of the fetus per vagina while the llama is rolled. If this method fails, cesarean section will be necessary. Correction by turning the fetus manually per vagina in a standing llama is not recommended. It is difficult to insert both arms and grasp the fetus above the elbows. A dead fetus in dystocia may require partial or complete fetotomy. Correction of the deviation and delivery of the dead fetus should be attempted first because the small size of the birth canal restricts the use of elaborate fetotomy instruments. Cesarean section is an appropriate alternative when the birth canal does not dilate sufficiently. The surgical approach well suited to cesarean section or correction of uterine torsion is the parainguinal approach (see p. 97). The dam should be under general anesthesia for all uterine surgery. The mother and neonate may be weak following cesarean surgery or prolonged dystocia. To assure passive transfer of maternal immunoglobulins, the neonate can be tube fed the first colostrum soon after delivery. Milk colostrum can be collected from the dam while she is
OBSTETRICS, NEONATAL CARE AND CONGENITAL CONDITIONS
187
still recumbent or sedated. The dam should be encouraged to rise as soon as possible after surgery to promote bonding between mother and neonate. NEONATAL CARE Fetal Assessment Neonatal well being begins with a healthy fetus, and a healthy fetus depends on a healthy dam. Four weeks prior to parturition, the maternal immune system can be boosted to assure adequate colostral antibodies. If the dam has not been vaccinated previously, inoculations should be given twice; 3 to 4 weeks apart, completing the series 1 month prior to the expected delivery date. Recommended vaccinations include tetanus toxoid and a Clostridium perfringens (type C and D) toxoid. In selenium-deficient areas, the dam should be supplemented with a vitamin E-selenium injection within 4 weeks of parturition. During the last trimester, ultrasonography using a ventral abdominal approach can be used to assess fetal parameters such as heart rate and fetal activity. Fetal aorta diameters are used to assess fetal growth and predict birth weights in equine foals. I Early studies with llamas have shown the normal fetal aorta easy to visualize and measure at the caudal border of the heart; at 270 days of gestation, the aorta measures approximately 0.6 cm in diameter, and 0.7 to 0.9 cm by 310 days of gestation. Characteristics of the Neonate The baby llama also is called a "cria," a Spanish word applied to llamas from birth to weaning. Neonate is the term used for a newborn animal up to 2 weeks of age. Both terms will be used in this article. At delivery, the neonate normally is covered by an epidermal membrane that does not obstruct its breathing or mobility. The mother nuzzles and hums to the cria but does not lick or clean it. The normal neonate soon begins to struggle and usually is standing within the first hour. Average birth weights range from 8 to 14 kg. Crias less than 8 kg. are considered dysmature and may require special care. The heart rate normally is 60 to 100 beats per minute and respiration should be regular at 10 to 30 respirations per minute. Body temperature of the neonate may fluctuate initially within a range of 37.7° to 39.2° C.3 Signs of prematurity or dysmaturity include weakness, low birth weight, unerupted incisors, hyperextension of the fetlock joints, firm retention of toe caps, extremely silky wool, and floppy ears. These crias have difficulty maintaining normal body temperature, their suckle reflex is diminished, and respirations may be labored. Immediate Care of the Neonate Immediate care and inspection of the neonate should include navel dipping in seven per cent tincture of iodine, drying, weighing, a brief physical examination, and close inspection for evidence of nursing. The
188
JOANNE PAUL-MURPHY
dam's teats should be checked for presence of colostrum. Dysgalactica is a common postpartum problem in llamas. If all parameters are normal, the pair can be left alone and observed from a distance. Normal crias usually nurse within the first hour following delivery.13 Nursing frequency has been recorded at three to four nursings per hour, with most episodes being less than 30 seconds. 13 If the cria is not observed nursing within the first 6 hours, supportive care should be given. The mother does not physically stimulate the cria to urinate or defecate. Passage of meconium should occur within the first 18 to 20 hours and may be much sooner if the cria is nursing vigorously. Warm water enemas can be helpful if the cria is straining or has retained meconium. Weak babies also seem to benefit from an enema. Passive Transfer of Immunoglobulins Newborn llamas have an undeveloped immune system and are hypogammaglobulinemic. Lymphoid tissue may be present at birth but requires antigenic stimulation to develop its protective function. Because epithelial-chorial placentation prohibits transplacental immunoglobulin transfer in llamas, absorption of colostrum is necessary to provide passive immunity for the first few weeks. Newborn alpacas receiving colostrum showed a 70 per cent increase in total protein within 24 hours, mostly caused by absorption of gammaglobulins, both IgG and IgM.4 IgG accounts for greater than 85 per cent of the passively transferred proteins. 4 The period of immunoglobulin absorption is less than 24 hours, being most efficient within the first 8 to 12 hours following parturition. Serum concentrations of gammaglobulins decrease 50 per cent by 10 days of age. 4 Colostrum also provides local protection in the gut against pathogenic bacteria and endotoxins.l1 Detection of Neonatal Immunoglobulins Failure of passive transfer (FPT) of colostral immunoglobulins has been shown to be a major mortality factor in newborn alpacas in Peru. 5 Its contribution to neonatal llama morbidity and mortality in North America also is significant. Assessment of passive immunity is a critical factor when treating weak or dysmature neonates. Passive transfer is evaluated by measuring the concentration of serum immunoglobulins after sufficient time has elapsed to allow absorption of colostral globulins. The minimum time has not been determined for llamas, but 15 to 18 hours should be adequate. Studies of the alpaca neonate have shown a linear increase in gammaglobulins by 6 hours after birth, reaching a maximum of 2.4 g per dl at 24 hours. 4 The minimum level of gammaglobulins necessary for protection of the neonate is not known, so interpretation of the different assays remains subjective. Several assays have been applied to evaluate serum IgG levels, some more suitable to practitioner use than others. Radial immunodiffusion tests, specific for llama IgG, have been developed but are not widely available. 7 This assay takes at least 24 hours to complete.
OBSTETRICS, NEONATAL CARE AND CONGENITAL CONDITIONS
189
Protein electrophoresis is less specific for IgG and tends to be slower and less reliable. Serum globulins can be evaluated by measuring total protein and albumin and calculating the difference. This method also requires laboratory facilities, but is less expensive and can be done in a short period of time. Commercial field tests that rely on species-specific antibodies will not be accurate for the llama. Zinc sulfate turbidity tests are rapid and inexpensive and can be done in the field. The exact techniques and zinc sulfate concentrations used differ between the calf and foal and readings of postcolostral llamas tend to be lower than either. When interpreting tests, it is helpful to use a serum sample from the mother as a positive control. Visual interpretation of a zinc sulfate turbidity test is sufficient for detecting complete FPT. Refractometer measurement of total serum proteins is a useful quick assessment test. In calves and foals, large errors were encountered when attempting to estimate immunoglobulin on the basis of total protein measurement. 12•14 Similar inaccuracies also may occur in llamas, but presently it is recommended as an accessible test that is more quantitative than zinc sulfate turbidity tests, and should be interpreted in light of hydration state. Serum protein values less than 4.5 g per dl indicate a hypogammaglobulinemic neonate. If the history supports any possibility of FPT and the cria obviously is weak, immediate action should be taken. Table 1 compares serum globulin elements of the equine, bovine, alpaca, and llama neonates, pre- and post-suckling or colostrum administration. Treatment of Hypogammaglobulinemia
Colostrum Administration. Colostrum should be administered via stomach tube if the cria is less than 24 hours of age. Milking a llama can be a frustrating experience, with yields commonly less than 3 oz, even with oxytocin administration. Goat colostrum is the preferred substitute because of similarities in composition and because goats often are immunized for the same clostridial toxins that are of concern in llama immunization programs. Colostrum also provides the local beneficial effects of complement, protein, and glucose. The amount of colostrum to be given during the first 24 hours should be 8 to 10 per cent of body weight, to be delivered in 4 to 8 oz a1iquots. This usually requires feeding every 2 hours. The stomach tube should be passed to the distal esophagus to facilitate passage of colostrum into the third stomach compartment via the esophageal groove and thereby avoid stagnation in the first compartment. plasma Administration. Administration of plasma is the treatment of choice for FPT and also is used to raise immunoglobulin levels in septicemic crias. Plasma often is given in addition to colostrum because intestinal absorption of immunoglobulins may be irregular. Plasma should be administered parenterally, although oral administration will provide immunoglobulins when intestinal absorption is intact. Slow intravenous administration is the preferred route because it provides immediate elevation of serum immunoglobulins and permits large
2
1.36 1629
0 0
12
5.6
3.77
5.72 2.86 2.86 1.00 1453
4.31 3.02 1.29 0.26 13.0
POST
Total protein g/dl Albumin g/dl Globulin g/dl Gammaglobulin g/dl IgG mg/dl Reference
CALVES PRE
POST
PRE
FACTOR
FOALS
4.7 3.4 1.3 0 30
PRE
4
ALPACA
8.0 3.6 4.4 2.3 3000
POST
LLAMA
5.5-6.1 3.1-3.7 2.1-3.4 0.9-1.6 1180*
POST
*7 All other llama values given by author; n = 8
4.9-5.6 3.4-5.0 0.6-1.5 0.2-0.3 97.8*
PRE
Table 1. Comparison o/Serum Protein Values in Neonatal Foals, Calves, Alpacas, and Llamas: Pre- and 24 to 48 Hours Post-colostrum Intake
== 0<
~
c:
~
t"'
c:::
~
trl
Z
o z>
""-
o
""""" ~
OBSTETRICS, NEONATAL CARE AND CONGENITAL CONDITIONS
191
volumes to be monitored. Plasma administration via the intraperitoneal route has provided rapid blood levels as well. Whole blood is recommended when the neonate is anemic (packed cell volume [PCV] less than 18) or if separation of erythrocytes from the plasma is not possible. It is recommended to use the dam's blood for transfusion whenever possible. Administration of fresh plasma can begin immediately after collection and centrifugation. Plasma also can be stored frozen and thawed when needed. Plasma immunoglobulins can be concentrated by using the initial 50 per cent fraction obtained during thawing. 17 Plasma should be administered at a dose of 15 to 25 ml per kg, which results in approximately 150 to 250 ml being administered to a neonate llama. Larger volumes are recommended when treating severe FPT or septic crias. Approximately 20 per cent more volume is necessary to deliver a sufficient amount of globulins when using whole blood. Administration rates vary with the size and condition of the cria, with 100 ml per hour commonly employed. This slow rate helps avoid volume overload, hypertension, and pulmonary edema. The cria should be monitored for a possible transfusion reaction, which can result in an elevated heart rate, trembling, and dyspnea. This complication is very rare. Intensive Care Considerations
General Considerations. Current expansion of the llama industry has resulted in llama neonates being of significant economic value. Fortunately, veterinary medicine has made dramatic improvements in neonatal care in recent years. Many principles applied to llama neonatal care have been extrapolated from intensive care guidelines developed for the foal. 8 •9 Intensive care procedures are expensive and extremely time consuming. The prognosis for each neonate should be evaluated carefully and discussed with the owners as early as possible so the value of the animal can be weighed against the cost of treatment. The level of intensive care required will vary with each cria and heroic measures clearly are not indicated for every individual. Identification of high-risk crias follows guidelines similar to those for equine neonates. Assessment of the llama neonate prior to parturition is unsophisticated at this time. Common problems are identified after delivery, such as immaturity, failure of passive transfer, and septicemia. These conditions are related and frequently occur in the same cria. A standard protocol should be established for examination of the neonate. Early identification of congenital lesions will help determine the value of the cria. In addition to a thorough physical examination, the initial data base should include quick assessment of whole blood glucose, immunoglobulin levels (total protein refractometry or zinc turbidity test), and hydration status. Most compromised crias require immediate attention for respiratory distress, hypothermia, hypoglycemia, and hypogammaglobulinemia. Treatment of these conditions can follow therapeutic guidelines used for foals. Blood glucose will be
192
JOANNE PAUL-MURPHY
extremely low (30 to 70 mg per dl) if the cria has not nursed, and levels less than 50 mg per dl should be treated with infusion of a 10 per cent glucose solution. Frequent rechecks of blood glucose should be performed, especially if oral colostrum or milk replacer also are being given. Intravenous Catheterization. Most neonates receiving intensive care will require intravenous catheterization. Sterile technique is essential for the immunodeficient patient because this is a potential port of infection. Neonatal skin is very thin, avoiding the need for a skin incision, which often is used for adult llamas. The jugular vein is used most commonly, but saphenous veins are a useful alternative. Several catheter types have been used, with the 2-inch, IS-gauge Teflon catheters being easy to place. When administering fluids over several days or using hypertonic solutions, a longer (5.5-inch) flexible type of catheter is more suitable. The long, thin neck of the neonate predisposes stiff catheters to kinking and breaking. Retention of catheters is assisted by placement of a small amount of cyanoacrylate glue to bond the catheter hub to the skin. The hub then is sutured to the skin. Catheters usually are changed every 72 to 96 hours. Fluid and Electrolyte Therapy. The electrolyte and acid-base status of the neonate can be unpredictable and requires frequent monitoring and re-evaluation. Table 2 provides guidelines for perinatal electrolyte values, giving ranges for normal llamas pre- and post-colostrum, normal llamas less than 1 month of age, and the range of values seen in dysmature llamas treated at the University of California Veterinary Medical Teaching Hospital. Although the range is quite broad for dysmature llamas, the tendency is to find hypokalemia and hypochloremia. Sodium imbalances are rare, but mild hyponatremia may be seen. Most imbalances can be corrected with 0.9 per cent saline solution or a balanced electrolyte solution. Potassium (10 to 20 mEq per L) and glucose (5 to 10 per cent) usually are added to intravenous fluids. Serum potassium levels usually underestimate replacement requirements, so in severe hypokalemia, additional KCI should be given orally. Fluid maintenance requirements for the cria have not been established. Adult llamas have a lower fluid intake than other domestic animals. 3 The neonate has a larger surface area: body weight ratio than the adult and its fluid requirements are estimated to be 60 to SO ml per kg per day plus additional requirements caused by losses (diarrhea or elevated respiratory rate). The cria should be monitored closely for weight gain, urination, pulse quality, and signs of overhydration. As the cria's attitude improves, oral feeding of milk or milk replacer should supplement intravenous therapy. Metabolic acidosis is the most common acid-base derangement in the compromised cria. Volume expansion with a balanced electrolyte solution usually is sufficient to correct the acidosis. Arterial Blood-Gas Values. Normal arterial blood gas values have not been established for the llama neonate. Hypoxia is a common . component of prematurity, dysmaturity, prolonged recumbency, pneumonia, and septicemia. A Pa02 value of less than 60 mm Hg may
108-122
4.6-5.9
148-156
Normal: under 4 weeks
9.3-10.3
10.0-11.0 10.4-11.7 10.4-11.6 10.6-12.2 9.9-12.0
MG/DL
CALCIUM
7.0-11.2
5.6-5.8 5.7-7.0 5.0-9.6 4.9-8.6 4.3-9.4
MG/DL
PHOSPHATE
INORGANIC
*Ranges determined from neonates in northern California before and after first colostrum; n = 10 * *Ranges determined from neonates admitted to the University of California, Davis Veterinary Medical Teaching Hospital; n
Dysmature neonate
Postcolostrum neonate
MM/L
108-110 108-122 109-114 107 -118 103-122
MM/L
CHLORIDE
4.4-4.7 4.4-7.9 3.5-4.5 4.2-7.0 3.2-5.0
MM/L
POTASSIUM
147-157 149-154 148-151 148-153 144-152
Presuckle neonate
AGE GROUP
SODIUM
Table 2. Llama Postnatal Electrolytes
= 21
3
5 **
5
REFERENCE
~ ~
.....
~
Z
::j 0
z S!
(') 0
> t"'
~
~
z G":l z
(') 0
t::)
Z
>
~
=
>
(')
t"'
o-:l
> >
z
0
~
Z
u~
= 25
o-:l
~
o-:l
~
0t=
194
JOANNE PAUL-MURPHY
necessitate oxygen therapy, which can be provided by face mask, oxygen cage, or nasal catheter. If conservative administration does not correct the hypoxemia or there is concomitant hypercapnia, positive pressure ventilation is recommended. Supportive Techniques. Good nursing care is essential to successful intensive care therapy. When the cria is too weak to stand, it is best to move it to a warm, clean work area, preferably within the mother's sight. Heat supplementation may be necessary to prevent hypothermia. Llamas do not usually struggle or thrash, but padding does help to prevent decubital sores. Nursing care of the neonate includes frequent positional changes, bedding changes, chest coupage, extension and flexion of the limbs, and daily encouragement to stand. The umbilical stump should be treated with iodine two times daily. Preventative Medicine. Prophylactic measures should be taken with the weak neonate. Gastroduodenal ulcers are a common complication seen at necropsy. The ulcers usually are asymptomatic and nonperforating. The cause is not yet defined but it is recommended to keep administration of nonsteroidal anti-inflammatory drugs to a minimum. In an attempt to prevent development, administration of antisecretory and cytoprotective agents is recommended. If gastric reflux occurs after tube feeding, the volume administered should be decreased and the frequency of feedings increased. The use of antibiotics without evidence of infectious disease is a debatable practice. Blood cultures should be taken when the cria is first admitted if sepsis is suspected. The cria needing intensive care usually is immunocompromised and at a high risk of infection, and organisms cultured in hospital intensive care units often are difficult to control. For these reasons, broad-spectrum antibiotics commonly are administered intravenously following catheter placement. There are several reports of renal impairment following the use of aminoglycosides in young llamas. If aminoglycosides must be employed, based on culture sensitivities, then administration at a low dose (1 to 2 mg per kg every 8 to 12 hours) subcutaneously is recommended, and for as short a period as possible. This dose is empirical and pharmacokinetics of aminoglycosides need to be studied in the adult as well as the neonate llama. Vitamin E-selenium preparations can be given intramuscularly to neonates born in selenium-deficient regions. Tetanus is a rare disease in llamas and the ability of the comprised neonate to respond to vaccination is unknown. Tetanus antitoxin is not administered routinely unless there is high suspicion of exposure and the dam was not immunized.
CONGENITAL CONDITIONS Congenital conditions of llamas are a common concern of breeders and veterinarians. Although the frequency of congenital problems is not known for llamas, it would appear to be relatively high and they are
OBSTETRICS, NEONATAL CARE AND CONGENITAL CONDITIONS
195
extremely significant economically and biologically. Congenital defects are abnormalities of structure or function present at birth. Such pathological defects result from a disruption during embryologic or fetal development. Most conditions are obvious at birth but more subtle physical or biochemical defects may not manifest themselves until later in development. Etiology The cause of congenital diseases can be either environmental, genetic, or a combination of both. Genetic defects are caused by mutant genes or chromosomal abberations. Genetic conditions are considered inherited when transmitted from parent to offspring. Individual, noninherited chromosomal alterations can occur as well. Environmental factors can produce changes in any genotype and do not follow familial patterns. These include toxic plants, infectious agents, nutritional imbalances, or physical disturbances encountered by the mother during development of the embryo or fetus. Environmental factors can express the same phenotype as a heritable condition, such as arthrogryphosis or some cranio-facial defects. Scientific studies concerning the etiology of specific llama congenital diseases are not available and llama genetics is still in the descriptive phase. No breeding trials have been reported and artificial insemination and embryo transfer are not employed commonly in the llama industry, making for slow accumulation of observations. It is such a young industry that basic standards for viability, growth rate, fertility, and conformation still are not established. Reporting Congenital Conditions Reporting and documenting congenital defects by veterinarians and breeders is encouraged to help determine frequency and prevalence of congenital conditions. A detailed history is valuable and should include geographical region; possible exposure to teratogenic plants; exposure to viruses, radiation, or medications; feeding and management practices; maternal vaccination, health, and previous birthing records, and occurrence of previous congenital conditions. A standard postmortem examination can identify multiple conditions present in the same fetus. Clients should be informed of potential heritable conditions when they occur, especially if the defect is not lethal or life threatening. Diagnosing genetic conditions requires excellent records to establish intragenerational familial frequencies and patterns spanning generations. When a similar condition is known to be heritable in other species, heritability in the llama should be considered. Table 3 lists congenital conditions of the llama and other species with similar conditions in which inheritance has been confirmed. This does not automatically confirm a genetic etiology for the llama; remember that similar phenotypes can be caused by genetic or environmental factors.
196
JOANNE PAUL-MURPHY
Table 3.
Congenital Conditions of Llamas Classified by Body System CONFIRMED INHERITANCE
DEFECT
DESCRIPTION
Musculoskeletal System Angular limb Lateral or medial deformity deviation of the limb. Carpal valgus most common Coccygeal Anury vertebrae (tail) absent Permanent Arthrogryposis contracture in flexion Shortened long Arrested bones, femur, development of and metacarpus the long bones reported Abnormal Dwarfism longitudinal epiphyseal growth; shortened limbs, abnormal head Partial agenesis of Hemivertebra the vertebra, usually cervical Bilateral, medical Patella luxation luxation most common. Crouched position Extra digits, Polydactyly usually on the forelimb Lateral deviation of Scoliosis vertebral column Fusion of two or Syndactyly more digits Contracture of Tendon contracture tendons, digital flexors most common; single or multiple limbs affected Luxation of tibial Vertical talus tarsal bone Bilateral Weak flexor tendons overextension of phalangeal joints Facial Skeletal System Membranous or Choanal atresia osseous partition between nasal & pharyngeal cavities; mouth breathing
IN OTHER SPECIES *
DIAGNOSIS
Radiography
H
Physical exam
F
Physical exam Necropsy
B,E,O,P,H
Physical exam Radiography
F
Radiography
B,E,O,C,P,H
Radiography Necropsy
P
Physical exam
C,H
Physical exam Radiography
B,O,C,Ca,F,H
Physical exam Radiography Physical exam Radiography Physical exam
H B,Ca,H
Radiography Physical exam
Physical exam Contrast radiography (Rhinography)
H
197
OBSTETRICS, NEONATAL CARE AND CONGENITAL CONDITIONS
Table 3. Congenital Conditions of Llamas Classified by Body System (Continued) CONFIRMED INHERITANCE DEFECT
DESCRIPTION
Two orbits merge to form a single cavity, has appearance of one eye & usually no nasal opening Nonclosure of the Cleft palate soft &/or hard palate; food & liquids discharge from nares Facial bone Lateral deviation & dysgenesis hypoplasia most common forms; respiration impaired Shortening or Mandibular/ maxillary lengthening of dysgenesis the mandible or maxilla: brachygnathia, prognathia, micrognathia N arrow nasal Nasal stenosis passages, may impair inspiration Central Nervous System Cerebellum Cerebellar reduced; small & hypoplasia narrow cortex & folia Herniation of Encephalomeninges meningocele through a cranial defect Internal; increased Hydrocephalus CSF in ventricles caused by obstructed outflow Reproductive System Incomplete Cryptorchidism descent of one or both testes; may be ectopic Failure of Double cervix Mullerian ducts to fuse, complete or caudal portion affected
Synophthalmia
DIAGNOSIS
IN OTHER SPECIES *
Physical exam
Laryngoscopy
B,O,F,H
Physical exam
B
Physical exam
B,E,O,C,Ca,H
Physical exam Rhinoscopy
Necropsy
B,F,H
Necropsy
Necropsy
Ca,F,H
Physical exam May require exploratory surgery Vaginal exam
B,E,O,C,P,Ca,H
B
(continued)
198
JOANNE PAUL-MURPHY
Table 3.
Congenital Conditions of Llamas Classified by Body System (Continued) CONFIRMED INHERITANCE
DEFECT
Gonad hypoplasia/aplasia
Hypoplasia of vulva Phallocampsis Corkscrew curvature
Persistent frenulum Pseudohermaphrodite
Segmental aplasis of Mullerian ducts Oviduct Uterus Cervix Vagina Imperforate hymen Alimentary System Atresia ani
Atresia coli
Megaesophagus
Pyloric stenosis
DESCRIPTION
Total or partial lack of development of ovary or teste, unilateral or bilateral Infantile vulva or labia Deviation of the penis
Persistent band between ventral glans & prepuce Gonads of one sex with opposite or ambiguous genitalia
DIAGNOSIS
IN OTHER SPECIES
Rectal palpation Laparoscopy
B,O,H
Physical exam Vaginal exam Examine erect penis: may require anesthesia and electrostimulation Examination of glans penis
B B
B
Examine genitalia Hormone analysis, histology of gonads
E,O,C,P
Defective or absent development, usually unilateral, but maybe complete. May involve one or more sections
Rectal palpation Vaginal exam Ultrasonography
B,H
Anus not present, rectum ends as a blind pouch
Physical exam No feces, distended abdomen Rectal examination Contrast radiography
B,O,P,H
Segment of colon undeveloped, resulting in two blind pouches Dilation of esophagus, possible vagal nerve defect Restricted outflow from compartment 1 to duodenum
Contrast radiography (barium swallow) Laparotomy Necropsy
H
*
199
OBSTETRICS, NEONATAL CARE AND CONGENITAL CONDITIONS
Table 3.
Congenital Conditions of Llamas Classified by Body System (Continued) CONFIRMED INHERITANCE
DEFECT
DESCRIPTION
Cardiovascular System Atrial septal defect Hole in atrial septum, may have systolic murmur & split S-2 Normal fetal Patent foramen structure, may ovale stay patent 1-2 weeks after birth Persistent shunt Patent ductus from arteriosus pulmonary artery to aorta. Shunt usually from left to right, with continuous murmur Right aorta Persistent right develops aortic arch instead of left; left ductus forms a ring around esophagus, causing esophageal stenosis & regurgitation VSD, pulmonic Tetrology of Fallot stenosis, dextroaorta & right ventricle hypertrophy Opening between Ventricular septal right & left defect ventricle; holosystolic murmur Aorta arises from Transposition of right ventricle, the great pulmonary vessels artery from left ventricle. Septal defect orPDA necessary for crossHowof two circ~tions
DIAGNOSIS
IN OTHER SPECIES
*
Auscultation Echocardiography
Auscultation
Auscultation Echocardiography
Ca,H
Contrast radiography (barium swallow)
Ca
Electrocardiogram Cardiac catheterization Necropsy
Ca
Auscultation Echocardiography
B,O,Ca
Physical exam Necropsy
(continued)
200
JOANNE PAUL-MURPHY
Table 3.
Congenital Conditions of Llamas Classified by Body System (Continued) CONFIRMED INHERITANCE
DEFECT
Ophthalmic System Cataract Ectropion Entropion
Microphthalmia Distichiasis Persistent hyperplastic primary vitreous Iridal heterochromia Eyelid hypogenesis Miscellaneous Diaphragmatic hernia
Inguinal hernia
Renal aplasia
Supernumery teats Agenesis of a teat Umbilical hernia
DESCRIPTION
IN OTHER SPECIES *
DIAGNOSIS
Opacity of one or both lenses One or both eyelids everted Inversion of one or both eyelids Secondary conjunctivitis &/or keratitis common Reduced size of one or both globes Two rows of eyelashes, usually upper lid Persistence of hyloid vessels associated with posterior surface of the lens Abnormal iris color, usually blue & white; «glass eye" Reduced palpebral fissure
Ophthalmic exam
Protrusion of abdominal organs through diaphram into thorax Protrusion of abdominal organs through inguinal canal Lack of development of kidney, usually unilateral Extra teats Lack of one or more teats Defect in abdominal wall at umbilicus, usually corrects within 2-4 weeks
B,E,Ca,F,H
Ophthalmic exam Ophthalmic exam
B,O,H
Ophthalmic exam Ophthalmic exam Ophthalmic exam
Ca
Ophthalmic exam
B,P,Ca
Ophthalmic exam
H
Auscultation of chest Radiography
Ca,F,H
Physical exam
P
Rectal palpation Necropsy
H
Physical exam Physical exam
E,H
Physical exam
B,E,O,P,Ca,F
201
OBSTETRICS, NEONATAL CARE AND CONGENITAL CONDITIONS
Table 3.
Congenital Conditions of Llamas Classified by Body System (Continued) CONFIRMED INHERITANCE
DEFECT
Persistent urachus
DESCRIPTION
Allantoic stalk to bladder stays patent, may drip urine outside body or into abdomen
DIAGNOSIS
IN OTHER SPECIES
*
Physical exam Cystogram
*B = bovine; E = equine; 0 = ovine; C = caprine; P = porcine; Ca = canine; F = feline; H = human, Modified from Fowler ME: Medicine and Surgery of South American Camelids. Ames, The Iowa State University Press, 1989
SUMMARY Obstetrical care of the llama is very similar to other food animal and equine obstetrics. Understanding the few unique llama characteristics such as birthing from a standing position, no licking of the neonate by the mother, and the epidermal membrane covering the newborn, help give confidence when treating llamas. Dystocia is rare in the llama but when veterinary assistance is required, understanding the shape of the female pelvis aids in manipulations. Llama neonatal care is minimal for the healthy cria, but intensive care of a compromised cria is extremely demanding, and not always rewarding. The suggestions presented in this article are the result of 4 years' experience in providing care to many ill neonatal llamas. Several methods have been adapted from equine neonatal medicine used at the Veterinary Medical Teaching Hospital at the University of California. Basic physiological information concerning llama neonates, healthy and ill, is still being investigated. It is judicious to identify and discuss congenital problems in neonates prior to intensive support.
REFERENCES 1. Adams-Brendemuehl E, Pipers FS: Antepartum evaluations on the equine fetus. In Weir BI, Rowland IW, Allen WH, et al (eds): Equine Reproduction. IV. Proceedings of the Fourth International Symposium on Equine Reproduction. Calgary, Canada, 1986 2. Clover CK, Zarkower A: Immunologic responses in colostrum-fed and colostrum-deprived calves. Am I Vet Res 41:1002-1007, 1980 3. Fowler ME: Medicine and Surgery of South American Camelids. Ames, The Iowa State University Press, 1989 4. Garmendia AE, McGuire TC: Mechanism and isotypes involved in passive immunoglobulin transfer to the newborn alpaca (Lama pacos). Am I Vet Res 48:14651471, 1987 5. Garmendia AE, Palmer GH, DeMartini IC, et al: Failure of passive immunoglobulin
202
6. 7. 8. 9. 10. 11. 12. 13. 14.
15. 16. 17.
JOANNE PAUL-MURPHY
transfer: A major determinant of mortality in newborn alpacas (Lama pacos). Am J Vet Res 48:1472-1475, 1987 Johnson LW: Llama neonatal considerations. In Western States Veterinary Conference, Scientific Proceedings, 1988, pp 358 - 368 Jorgensen D: The significance of the development of immunity factors (IgG) in the newborn llama. Llama Association of North America, Bulletin #36 Koterba AM, Drummond WH, Kosch P: Intensive care of the neonatal foal. In Beech J (ed): Veterinary Clinics of North America (Equine Practice) Neonatal Equine Disease. Philadelphia, WB Saunders, 1985 Madigan JE (ed): Manual of Equine Neonatal Medicine. Woodland, Live Oak Publishing, 1987 Musa BE: A new epidermal membrane associated with the foetus of the camel Camelus dromedarius. Zbl Vet Med C Anat Histol Embryol 6:355-358, 1977 Naylor JM: Colostrum and passive immunity in food-producing animals. In Howard, JL (ed): Current Veterinary Therapy: Food Animal Practice. 2. Philadelphia, WB Saunders, 1986, p 99 Pfeiffer NE, McGuire TC, Bendel RB, et al: Quantitation of bovine immunoglobulins: Comparison of single radial immunodiffusion, zinc sulfate turbidity, serum electrophoresis, and refractometer methods. Am J Vet Res 38:693-698, 1977 Prescott J: Suckling behavior of llama (Lama glama glama) and Chapman's zebra (Equus burchelli antiquorum) in captivity. Appl An Ethiol 7:293-299, 1981 Rumbaugh GE, Ardans AA, Cinno D, et al: Measurement of neonatal equine immunoglobulins for assessment of colostral immunoglobulin transfer: Comparison of single radial immunodiffusion with zinc sulfate turbidity test, serum electrophoresis, refractometry for total serum protein, and the sodium-sulfite precipitation test. J Am Vet Med Assoc 172:321-325, 1978 Steven DH, Burton J, Sumar J, et al: Ultrastructural observations on the placenta of the alpaca (Lama pacos). Placenta 1:21-32, 1980 Sumar J, Novoa C, Fernandez-Baca S: Fisiologia reproductiva post-partum en la alpaca. Rev Inv Pec 1:21-27, 1972 Thomas KW, Pemberton DH: A freeze-thaw method for concentrating plasma and serum for treatment ofhypogammaglobulinemia. AJEBAK 58:133-142,1980
Department of Veterinary Medicine School of Veterinary Medicine University of California Davis, CA 95616
0749-0720/89 $0.00
+ .20
Obstetrics, Neonatal Care, and Congenital Conditions Joanne Paul-Murphy, DVM*
OBSTETRICS Llama gestation has an average length of 335 to 350 days, but has been known to extend beyond 1 year. Most births occur rapidly and, typically, during daylight hours. Knowledge of breeding dates permits early separation of the dam from the herd into a maternity area for close observation of parturition. It is best not to move or disturb a llama after labor has begun unless signs of dystocia are evident because this may prolong the delivery. Signs of approaching parturition in the llama are subtle and may include relaxation of the vulva and slight increase in size of the udder. Multiparous females may display waxing at the tips of the teats. Stages of Labor Normal labor is a continuous process but is divided into three stages for descriptive purposes. Stage 1 is characterized by uterine contractions and dilation of the cervix to allow the fetus to enter the birth canal. Duration of this phase is variable, and there may be no outward signs of uterine contractions. Behavioral changes include restlessness, humming, increased urination, decreased appetite, and segregation from the herd. There is no indication for intervention at this stage, and it is best to allow some privacy to the dam. Second-stage labor begins when the fetus enters the birth canal and initiates active expulsion. Delivery normally occurs within 60 to 90 minutes. Abdominal pressing will be obvious, and the dam may lie down and get up several times. The chorion usually ruptures during this stage, and the amnionic sac may appear at the vulva and rupture as
*Visiting Professor Department of Veterinary Medicine, School of Veterinary Medicine, University of California, Davis, California 95616
Veterinary Clinics o/North America: Food Animal Practice-Vol. 5, No.1, March 1989
183
184
JOANNE PAUL-MURPHY
well. The amount of fluid lost following membrane rupture is reduced relative to other domestic animals. The epidermal membrane, unique to camelids, remains intact until delivery of the fetus. 3 ,10 This thin membrane lies close to the body and attaches at the umbilicus, hoof coronet, anus, genital opening, mouth, and nares. It is rubbed off as the neonate struggles after delivery. Most llamas deliver in a standing position. Normal presentation is cranial, with dorsal-sacral positioning. Both forelimbs appear together at the vulva, and the head emerges either above or below the legs. The dam may rest before expelling the shoulders. The umbilical cord ruptures as the fetus leaves the birth canal. The third stage of parturition is expulsion of the placenta, which usually passes within 45 minutes of delivery of the fetus and should not exceed a few hours. IS Llama placentas, exclusive of the allantoic fluid, weigh between 0.74 and 1.44 kg. 3 Llamas do not eat the placenta, so the birthing area should be inspected to locate the membranes following an unattended birth. Retained Placenta Retained placenta is a rare complication in llamas. Failure to pass the placenta after 6 to 8 hours warrants treatment of the dam. Manual removal is not recommended. Oxytocin and uterine saline lavage help stimulate uterine contractions and release of fetal membranes. If the placenta is retained greater than 24 hours, repeated saline lavages or antibiotic boluses will help prevent metritis. Involution Uterine involution progresses rapidly and returns the uterus to normal size by 21 days.6,16 A small amount of lochia is normal for the first 5 to 7 days. It may be slightly opaque to dark reddish-brown in color. Llamas will rebreed readily after birthing, even on the same day, but rarely conceive. Conception rates are reported to be higher when the female is bred at 2 to 4 weeks postpartum than when rebred at 2 to 3 months. Dystocia The incidence of dystocia in the llama is low (estimated two to five per cent) but all dystocias require assistance because of the long limbs and neck of the fetus. It is important that owners check near term females frequently so that early intervention is possible if a dystocia develops. Dystocia occurs when any stage of parturition is prolonged or interrupted. Assistance is necessary if first-stage labor exceeds 6 hours without initiating abdominal contractions, or second-stage labor extends beyond 2 hours without signs of progression. In primiparous females, dystocia usually is related to disproportion between fetal size and pelvic dimensions of the dam. Most llama dystocias are caused by fetal abnormalities in presentation, position, posture, or, less frequently, teratogenic defects. Dystocia examination is accomplished best with the animal stand-
185
OBSTETRICS, NEONATAL CARE AND CONGENITAL CONDITIONS
ing and properly restrained. The tail should be wrapped and tied to the side. While preparing and cleaning the perineal region, a history should be obtained from the caretaker regarding gestation length, duration of labor, and degree of prior intervention. With disinfected and lubricated arms, examine the birth canal for cervical dilation, strictures, and size of pelvic region. Examine the birth canal carefully for tears if it has been examined previously. Determine whether the fetus is alive or dead because this affects the course of management. A live fetus will respond to pinching between the toes, pushing gently on the eyes, gently pulling the tongue or inserting a finger in the rectum. If response is uncertain, try to palpate a pulse at the umbilicus. Manual dilation of the birth canal may be necessary. In small llamas and alpacas only one hand may fit into the vagina initially. Using abundant lubrication, insert the hand with palm outwards and press against the vaginal wall while moving around the perimeter. Traction should be applied to the fetus only after the birth canal is dilated. Shoulder lock is the most frequent problem with maternal: fetal disproportion. Rotation of the fetus 45 to 90 degrees will align the greatest width of the shoulders to the maximum dimension of the maternal pelvis (Fig. 1). This must be done before the shoulders engage in the pelvis, otherwise the fetus needs to be repelled and rotated. Apply traction along the longitudinal axis of the fetus. Traction on the legs should alternate between forelimbs so the shoulders pass through the pelvis separately. If both shoulders cannot be delivered, try manipulating the fetus with the dam in lateral recumbency and if this is unsuccessful, a cesarean section should be considered.
A. 5.25" B. 5.75" C.6.0"
Figure 1.
Shape and dimensions of the average female llama pelvis.
186
JOANNE PAUL-MURPHY
Locking at the hips is much less common. It usually can be corrected by placing the dam in lateral recumbancy, repelling the fetus, rotating it 45 degrees, then applying traction by pulling the fetus across the dam's flank. This angles the fetal hips across the widest pelvic dimension. The nostrils and mouth should be cleared and respiration stimulated prior to hiplock manipulations. Cranial presentation also can present with postural deviations of the head and limbs. The manipulations to correct forelimb retentions (flexed shoulder or flexed elbow) are similar to those used to correct similar malpostures in the equine. Deviations of the head and neck are difficult to correct because of the long, thin neck of the fetus. Flexion of the neck backwards or to the right or left side of the fetus is common. Forelimb retention may occur in association with this posture, which can lock the fetal thorax in the pelvic region. If only one arm can enter the birth canal, a snare can be looped around the head or lower jaw. The chest must be repelled while traction is used to pull the head into proper position. This may deliver the head upside-down, necessitating rotation to the upright position within the birth canal. If no progress can be made to straighten the neck, the fetus should be palpated carefully for possible torticollis. Caudal and breech presentations are serious dystocias. These presentations result in prolonged pressure on the umbilicus as it passes through the pelvis. Manual dilation of the birth canal often is necessary. Traction is applied only when the dam pushes, to avoid early rupture of the umbilicus. Cesarean section should be considered if extraction is difficult and extends beyond 15 minutes. When palpation reveals an upside-down fetus, it should be kept in mind that uterine torsion occurs more frequently than this malposition. In uterine torsion, the cervix often is partially dilated. Palpate the birth canal for spiral folds. Rectal palpation is necessary to feel the broad ligament and determine direction of torsion. Most cases are twisted 180 degrees or less. Rolling the dam with pressure applied across the abdomen, using a plank, is the least traumatic technique for correction. If the cervix is open, grasp the legs of the fetus per vagina while the llama is rolled. If this method fails, cesarean section will be necessary. Correction by turning the fetus manually per vagina in a standing llama is not recommended. It is difficult to insert both arms and grasp the fetus above the elbows. A dead fetus in dystocia may require partial or complete fetotomy. Correction of the deviation and delivery of the dead fetus should be attempted first because the small size of the birth canal restricts the use of elaborate fetotomy instruments. Cesarean section is an appropriate alternative when the birth canal does not dilate sufficiently. The surgical approach well suited to cesarean section or correction of uterine torsion is the parainguinal approach (see p. 97). The dam should be under general anesthesia for all uterine surgery. The mother and neonate may be weak following cesarean surgery or prolonged dystocia. To assure passive transfer of maternal immunoglobulins, the neonate can be tube fed the first colostrum soon after delivery. Milk colostrum can be collected from the dam while she is
OBSTETRICS, NEONATAL CARE AND CONGENITAL CONDITIONS
187
still recumbent or sedated. The dam should be encouraged to rise as soon as possible after surgery to promote bonding between mother and neonate. NEONATAL CARE Fetal Assessment Neonatal well being begins with a healthy fetus, and a healthy fetus depends on a healthy dam. Four weeks prior to parturition, the maternal immune system can be boosted to assure adequate colostral antibodies. If the dam has not been vaccinated previously, inoculations should be given twice; 3 to 4 weeks apart, completing the series 1 month prior to the expected delivery date. Recommended vaccinations include tetanus toxoid and a Clostridium perfringens (type C and D) toxoid. In selenium-deficient areas, the dam should be supplemented with a vitamin E-selenium injection within 4 weeks of parturition. During the last trimester, ultrasonography using a ventral abdominal approach can be used to assess fetal parameters such as heart rate and fetal activity. Fetal aorta diameters are used to assess fetal growth and predict birth weights in equine foals. I Early studies with llamas have shown the normal fetal aorta easy to visualize and measure at the caudal border of the heart; at 270 days of gestation, the aorta measures approximately 0.6 cm in diameter, and 0.7 to 0.9 cm by 310 days of gestation. Characteristics of the Neonate The baby llama also is called a "cria," a Spanish word applied to llamas from birth to weaning. Neonate is the term used for a newborn animal up to 2 weeks of age. Both terms will be used in this article. At delivery, the neonate normally is covered by an epidermal membrane that does not obstruct its breathing or mobility. The mother nuzzles and hums to the cria but does not lick or clean it. The normal neonate soon begins to struggle and usually is standing within the first hour. Average birth weights range from 8 to 14 kg. Crias less than 8 kg. are considered dysmature and may require special care. The heart rate normally is 60 to 100 beats per minute and respiration should be regular at 10 to 30 respirations per minute. Body temperature of the neonate may fluctuate initially within a range of 37.7° to 39.2° C.3 Signs of prematurity or dysmaturity include weakness, low birth weight, unerupted incisors, hyperextension of the fetlock joints, firm retention of toe caps, extremely silky wool, and floppy ears. These crias have difficulty maintaining normal body temperature, their suckle reflex is diminished, and respirations may be labored. Immediate Care of the Neonate Immediate care and inspection of the neonate should include navel dipping in seven per cent tincture of iodine, drying, weighing, a brief physical examination, and close inspection for evidence of nursing. The
188
JOANNE PAUL-MURPHY
dam's teats should be checked for presence of colostrum. Dysgalactica is a common postpartum problem in llamas. If all parameters are normal, the pair can be left alone and observed from a distance. Normal crias usually nurse within the first hour following delivery.13 Nursing frequency has been recorded at three to four nursings per hour, with most episodes being less than 30 seconds. 13 If the cria is not observed nursing within the first 6 hours, supportive care should be given. The mother does not physically stimulate the cria to urinate or defecate. Passage of meconium should occur within the first 18 to 20 hours and may be much sooner if the cria is nursing vigorously. Warm water enemas can be helpful if the cria is straining or has retained meconium. Weak babies also seem to benefit from an enema. Passive Transfer of Immunoglobulins Newborn llamas have an undeveloped immune system and are hypogammaglobulinemic. Lymphoid tissue may be present at birth but requires antigenic stimulation to develop its protective function. Because epithelial-chorial placentation prohibits transplacental immunoglobulin transfer in llamas, absorption of colostrum is necessary to provide passive immunity for the first few weeks. Newborn alpacas receiving colostrum showed a 70 per cent increase in total protein within 24 hours, mostly caused by absorption of gammaglobulins, both IgG and IgM.4 IgG accounts for greater than 85 per cent of the passively transferred proteins. 4 The period of immunoglobulin absorption is less than 24 hours, being most efficient within the first 8 to 12 hours following parturition. Serum concentrations of gammaglobulins decrease 50 per cent by 10 days of age. 4 Colostrum also provides local protection in the gut against pathogenic bacteria and endotoxins.l1 Detection of Neonatal Immunoglobulins Failure of passive transfer (FPT) of colostral immunoglobulins has been shown to be a major mortality factor in newborn alpacas in Peru. 5 Its contribution to neonatal llama morbidity and mortality in North America also is significant. Assessment of passive immunity is a critical factor when treating weak or dysmature neonates. Passive transfer is evaluated by measuring the concentration of serum immunoglobulins after sufficient time has elapsed to allow absorption of colostral globulins. The minimum time has not been determined for llamas, but 15 to 18 hours should be adequate. Studies of the alpaca neonate have shown a linear increase in gammaglobulins by 6 hours after birth, reaching a maximum of 2.4 g per dl at 24 hours. 4 The minimum level of gammaglobulins necessary for protection of the neonate is not known, so interpretation of the different assays remains subjective. Several assays have been applied to evaluate serum IgG levels, some more suitable to practitioner use than others. Radial immunodiffusion tests, specific for llama IgG, have been developed but are not widely available. 7 This assay takes at least 24 hours to complete.
OBSTETRICS, NEONATAL CARE AND CONGENITAL CONDITIONS
189
Protein electrophoresis is less specific for IgG and tends to be slower and less reliable. Serum globulins can be evaluated by measuring total protein and albumin and calculating the difference. This method also requires laboratory facilities, but is less expensive and can be done in a short period of time. Commercial field tests that rely on species-specific antibodies will not be accurate for the llama. Zinc sulfate turbidity tests are rapid and inexpensive and can be done in the field. The exact techniques and zinc sulfate concentrations used differ between the calf and foal and readings of postcolostral llamas tend to be lower than either. When interpreting tests, it is helpful to use a serum sample from the mother as a positive control. Visual interpretation of a zinc sulfate turbidity test is sufficient for detecting complete FPT. Refractometer measurement of total serum proteins is a useful quick assessment test. In calves and foals, large errors were encountered when attempting to estimate immunoglobulin on the basis of total protein measurement. 12•14 Similar inaccuracies also may occur in llamas, but presently it is recommended as an accessible test that is more quantitative than zinc sulfate turbidity tests, and should be interpreted in light of hydration state. Serum protein values less than 4.5 g per dl indicate a hypogammaglobulinemic neonate. If the history supports any possibility of FPT and the cria obviously is weak, immediate action should be taken. Table 1 compares serum globulin elements of the equine, bovine, alpaca, and llama neonates, pre- and post-suckling or colostrum administration. Treatment of Hypogammaglobulinemia
Colostrum Administration. Colostrum should be administered via stomach tube if the cria is less than 24 hours of age. Milking a llama can be a frustrating experience, with yields commonly less than 3 oz, even with oxytocin administration. Goat colostrum is the preferred substitute because of similarities in composition and because goats often are immunized for the same clostridial toxins that are of concern in llama immunization programs. Colostrum also provides the local beneficial effects of complement, protein, and glucose. The amount of colostrum to be given during the first 24 hours should be 8 to 10 per cent of body weight, to be delivered in 4 to 8 oz a1iquots. This usually requires feeding every 2 hours. The stomach tube should be passed to the distal esophagus to facilitate passage of colostrum into the third stomach compartment via the esophageal groove and thereby avoid stagnation in the first compartment. plasma Administration. Administration of plasma is the treatment of choice for FPT and also is used to raise immunoglobulin levels in septicemic crias. Plasma often is given in addition to colostrum because intestinal absorption of immunoglobulins may be irregular. Plasma should be administered parenterally, although oral administration will provide immunoglobulins when intestinal absorption is intact. Slow intravenous administration is the preferred route because it provides immediate elevation of serum immunoglobulins and permits large
2
1.36 1629
0 0
12
5.6
3.77
5.72 2.86 2.86 1.00 1453
4.31 3.02 1.29 0.26 13.0
POST
Total protein g/dl Albumin g/dl Globulin g/dl Gammaglobulin g/dl IgG mg/dl Reference
CALVES PRE
POST
PRE
FACTOR
FOALS
4.7 3.4 1.3 0 30
PRE
4
ALPACA
8.0 3.6 4.4 2.3 3000
POST
LLAMA
5.5-6.1 3.1-3.7 2.1-3.4 0.9-1.6 1180*
POST
*7 All other llama values given by author; n = 8
4.9-5.6 3.4-5.0 0.6-1.5 0.2-0.3 97.8*
PRE
Table 1. Comparison o/Serum Protein Values in Neonatal Foals, Calves, Alpacas, and Llamas: Pre- and 24 to 48 Hours Post-colostrum Intake
== 0<
~
c:
~
t"'
c:::
~
trl
Z
o z>
""-
o
""""" ~
OBSTETRICS, NEONATAL CARE AND CONGENITAL CONDITIONS
191
volumes to be monitored. Plasma administration via the intraperitoneal route has provided rapid blood levels as well. Whole blood is recommended when the neonate is anemic (packed cell volume [PCV] less than 18) or if separation of erythrocytes from the plasma is not possible. It is recommended to use the dam's blood for transfusion whenever possible. Administration of fresh plasma can begin immediately after collection and centrifugation. Plasma also can be stored frozen and thawed when needed. Plasma immunoglobulins can be concentrated by using the initial 50 per cent fraction obtained during thawing. 17 Plasma should be administered at a dose of 15 to 25 ml per kg, which results in approximately 150 to 250 ml being administered to a neonate llama. Larger volumes are recommended when treating severe FPT or septic crias. Approximately 20 per cent more volume is necessary to deliver a sufficient amount of globulins when using whole blood. Administration rates vary with the size and condition of the cria, with 100 ml per hour commonly employed. This slow rate helps avoid volume overload, hypertension, and pulmonary edema. The cria should be monitored for a possible transfusion reaction, which can result in an elevated heart rate, trembling, and dyspnea. This complication is very rare. Intensive Care Considerations
General Considerations. Current expansion of the llama industry has resulted in llama neonates being of significant economic value. Fortunately, veterinary medicine has made dramatic improvements in neonatal care in recent years. Many principles applied to llama neonatal care have been extrapolated from intensive care guidelines developed for the foal. 8 •9 Intensive care procedures are expensive and extremely time consuming. The prognosis for each neonate should be evaluated carefully and discussed with the owners as early as possible so the value of the animal can be weighed against the cost of treatment. The level of intensive care required will vary with each cria and heroic measures clearly are not indicated for every individual. Identification of high-risk crias follows guidelines similar to those for equine neonates. Assessment of the llama neonate prior to parturition is unsophisticated at this time. Common problems are identified after delivery, such as immaturity, failure of passive transfer, and septicemia. These conditions are related and frequently occur in the same cria. A standard protocol should be established for examination of the neonate. Early identification of congenital lesions will help determine the value of the cria. In addition to a thorough physical examination, the initial data base should include quick assessment of whole blood glucose, immunoglobulin levels (total protein refractometry or zinc turbidity test), and hydration status. Most compromised crias require immediate attention for respiratory distress, hypothermia, hypoglycemia, and hypogammaglobulinemia. Treatment of these conditions can follow therapeutic guidelines used for foals. Blood glucose will be
192
JOANNE PAUL-MURPHY
extremely low (30 to 70 mg per dl) if the cria has not nursed, and levels less than 50 mg per dl should be treated with infusion of a 10 per cent glucose solution. Frequent rechecks of blood glucose should be performed, especially if oral colostrum or milk replacer also are being given. Intravenous Catheterization. Most neonates receiving intensive care will require intravenous catheterization. Sterile technique is essential for the immunodeficient patient because this is a potential port of infection. Neonatal skin is very thin, avoiding the need for a skin incision, which often is used for adult llamas. The jugular vein is used most commonly, but saphenous veins are a useful alternative. Several catheter types have been used, with the 2-inch, IS-gauge Teflon catheters being easy to place. When administering fluids over several days or using hypertonic solutions, a longer (5.5-inch) flexible type of catheter is more suitable. The long, thin neck of the neonate predisposes stiff catheters to kinking and breaking. Retention of catheters is assisted by placement of a small amount of cyanoacrylate glue to bond the catheter hub to the skin. The hub then is sutured to the skin. Catheters usually are changed every 72 to 96 hours. Fluid and Electrolyte Therapy. The electrolyte and acid-base status of the neonate can be unpredictable and requires frequent monitoring and re-evaluation. Table 2 provides guidelines for perinatal electrolyte values, giving ranges for normal llamas pre- and post-colostrum, normal llamas less than 1 month of age, and the range of values seen in dysmature llamas treated at the University of California Veterinary Medical Teaching Hospital. Although the range is quite broad for dysmature llamas, the tendency is to find hypokalemia and hypochloremia. Sodium imbalances are rare, but mild hyponatremia may be seen. Most imbalances can be corrected with 0.9 per cent saline solution or a balanced electrolyte solution. Potassium (10 to 20 mEq per L) and glucose (5 to 10 per cent) usually are added to intravenous fluids. Serum potassium levels usually underestimate replacement requirements, so in severe hypokalemia, additional KCI should be given orally. Fluid maintenance requirements for the cria have not been established. Adult llamas have a lower fluid intake than other domestic animals. 3 The neonate has a larger surface area: body weight ratio than the adult and its fluid requirements are estimated to be 60 to SO ml per kg per day plus additional requirements caused by losses (diarrhea or elevated respiratory rate). The cria should be monitored closely for weight gain, urination, pulse quality, and signs of overhydration. As the cria's attitude improves, oral feeding of milk or milk replacer should supplement intravenous therapy. Metabolic acidosis is the most common acid-base derangement in the compromised cria. Volume expansion with a balanced electrolyte solution usually is sufficient to correct the acidosis. Arterial Blood-Gas Values. Normal arterial blood gas values have not been established for the llama neonate. Hypoxia is a common . component of prematurity, dysmaturity, prolonged recumbency, pneumonia, and septicemia. A Pa02 value of less than 60 mm Hg may
108-122
4.6-5.9
148-156
Normal: under 4 weeks
9.3-10.3
10.0-11.0 10.4-11.7 10.4-11.6 10.6-12.2 9.9-12.0
MG/DL
CALCIUM
7.0-11.2
5.6-5.8 5.7-7.0 5.0-9.6 4.9-8.6 4.3-9.4
MG/DL
PHOSPHATE
INORGANIC
*Ranges determined from neonates in northern California before and after first colostrum; n = 10 * *Ranges determined from neonates admitted to the University of California, Davis Veterinary Medical Teaching Hospital; n
Dysmature neonate
Postcolostrum neonate
MM/L
108-110 108-122 109-114 107 -118 103-122
MM/L
CHLORIDE
4.4-4.7 4.4-7.9 3.5-4.5 4.2-7.0 3.2-5.0
MM/L
POTASSIUM
147-157 149-154 148-151 148-153 144-152
Presuckle neonate
AGE GROUP
SODIUM
Table 2. Llama Postnatal Electrolytes
= 21
3
5 **
5
REFERENCE
~ ~
.....
~
Z
::j 0
z S!
(') 0
> t"'
~
~
z G":l z
(') 0
t::)
Z
>
~
=
>
(')
t"'
o-:l
> >
z
0
~
Z
u~
= 25
o-:l
~
o-:l
~
0t=
194
JOANNE PAUL-MURPHY
necessitate oxygen therapy, which can be provided by face mask, oxygen cage, or nasal catheter. If conservative administration does not correct the hypoxemia or there is concomitant hypercapnia, positive pressure ventilation is recommended. Supportive Techniques. Good nursing care is essential to successful intensive care therapy. When the cria is too weak to stand, it is best to move it to a warm, clean work area, preferably within the mother's sight. Heat supplementation may be necessary to prevent hypothermia. Llamas do not usually struggle or thrash, but padding does help to prevent decubital sores. Nursing care of the neonate includes frequent positional changes, bedding changes, chest coupage, extension and flexion of the limbs, and daily encouragement to stand. The umbilical stump should be treated with iodine two times daily. Preventative Medicine. Prophylactic measures should be taken with the weak neonate. Gastroduodenal ulcers are a common complication seen at necropsy. The ulcers usually are asymptomatic and nonperforating. The cause is not yet defined but it is recommended to keep administration of nonsteroidal anti-inflammatory drugs to a minimum. In an attempt to prevent development, administration of antisecretory and cytoprotective agents is recommended. If gastric reflux occurs after tube feeding, the volume administered should be decreased and the frequency of feedings increased. The use of antibiotics without evidence of infectious disease is a debatable practice. Blood cultures should be taken when the cria is first admitted if sepsis is suspected. The cria needing intensive care usually is immunocompromised and at a high risk of infection, and organisms cultured in hospital intensive care units often are difficult to control. For these reasons, broad-spectrum antibiotics commonly are administered intravenously following catheter placement. There are several reports of renal impairment following the use of aminoglycosides in young llamas. If aminoglycosides must be employed, based on culture sensitivities, then administration at a low dose (1 to 2 mg per kg every 8 to 12 hours) subcutaneously is recommended, and for as short a period as possible. This dose is empirical and pharmacokinetics of aminoglycosides need to be studied in the adult as well as the neonate llama. Vitamin E-selenium preparations can be given intramuscularly to neonates born in selenium-deficient regions. Tetanus is a rare disease in llamas and the ability of the comprised neonate to respond to vaccination is unknown. Tetanus antitoxin is not administered routinely unless there is high suspicion of exposure and the dam was not immunized.
CONGENITAL CONDITIONS Congenital conditions of llamas are a common concern of breeders and veterinarians. Although the frequency of congenital problems is not known for llamas, it would appear to be relatively high and they are
OBSTETRICS, NEONATAL CARE AND CONGENITAL CONDITIONS
195
extremely significant economically and biologically. Congenital defects are abnormalities of structure or function present at birth. Such pathological defects result from a disruption during embryologic or fetal development. Most conditions are obvious at birth but more subtle physical or biochemical defects may not manifest themselves until later in development. Etiology The cause of congenital diseases can be either environmental, genetic, or a combination of both. Genetic defects are caused by mutant genes or chromosomal abberations. Genetic conditions are considered inherited when transmitted from parent to offspring. Individual, noninherited chromosomal alterations can occur as well. Environmental factors can produce changes in any genotype and do not follow familial patterns. These include toxic plants, infectious agents, nutritional imbalances, or physical disturbances encountered by the mother during development of the embryo or fetus. Environmental factors can express the same phenotype as a heritable condition, such as arthrogryphosis or some cranio-facial defects. Scientific studies concerning the etiology of specific llama congenital diseases are not available and llama genetics is still in the descriptive phase. No breeding trials have been reported and artificial insemination and embryo transfer are not employed commonly in the llama industry, making for slow accumulation of observations. It is such a young industry that basic standards for viability, growth rate, fertility, and conformation still are not established. Reporting Congenital Conditions Reporting and documenting congenital defects by veterinarians and breeders is encouraged to help determine frequency and prevalence of congenital conditions. A detailed history is valuable and should include geographical region; possible exposure to teratogenic plants; exposure to viruses, radiation, or medications; feeding and management practices; maternal vaccination, health, and previous birthing records, and occurrence of previous congenital conditions. A standard postmortem examination can identify multiple conditions present in the same fetus. Clients should be informed of potential heritable conditions when they occur, especially if the defect is not lethal or life threatening. Diagnosing genetic conditions requires excellent records to establish intragenerational familial frequencies and patterns spanning generations. When a similar condition is known to be heritable in other species, heritability in the llama should be considered. Table 3 lists congenital conditions of the llama and other species with similar conditions in which inheritance has been confirmed. This does not automatically confirm a genetic etiology for the llama; remember that similar phenotypes can be caused by genetic or environmental factors.
196
JOANNE PAUL-MURPHY
Table 3.
Congenital Conditions of Llamas Classified by Body System CONFIRMED INHERITANCE
DEFECT
DESCRIPTION
Musculoskeletal System Angular limb Lateral or medial deformity deviation of the limb. Carpal valgus most common Coccygeal Anury vertebrae (tail) absent Permanent Arthrogryposis contracture in flexion Shortened long Arrested bones, femur, development of and metacarpus the long bones reported Abnormal Dwarfism longitudinal epiphyseal growth; shortened limbs, abnormal head Partial agenesis of Hemivertebra the vertebra, usually cervical Bilateral, medical Patella luxation luxation most common. Crouched position Extra digits, Polydactyly usually on the forelimb Lateral deviation of Scoliosis vertebral column Fusion of two or Syndactyly more digits Contracture of Tendon contracture tendons, digital flexors most common; single or multiple limbs affected Luxation of tibial Vertical talus tarsal bone Bilateral Weak flexor tendons overextension of phalangeal joints Facial Skeletal System Membranous or Choanal atresia osseous partition between nasal & pharyngeal cavities; mouth breathing
IN OTHER SPECIES *
DIAGNOSIS
Radiography
H
Physical exam
F
Physical exam Necropsy
B,E,O,P,H
Physical exam Radiography
F
Radiography
B,E,O,C,P,H
Radiography Necropsy
P
Physical exam
C,H
Physical exam Radiography
B,O,C,Ca,F,H
Physical exam Radiography Physical exam Radiography Physical exam
H B,Ca,H
Radiography Physical exam
Physical exam Contrast radiography (Rhinography)
H
197
OBSTETRICS, NEONATAL CARE AND CONGENITAL CONDITIONS
Table 3. Congenital Conditions of Llamas Classified by Body System (Continued) CONFIRMED INHERITANCE DEFECT
DESCRIPTION
Two orbits merge to form a single cavity, has appearance of one eye & usually no nasal opening Nonclosure of the Cleft palate soft &/or hard palate; food & liquids discharge from nares Facial bone Lateral deviation & dysgenesis hypoplasia most common forms; respiration impaired Shortening or Mandibular/ maxillary lengthening of dysgenesis the mandible or maxilla: brachygnathia, prognathia, micrognathia N arrow nasal Nasal stenosis passages, may impair inspiration Central Nervous System Cerebellum Cerebellar reduced; small & hypoplasia narrow cortex & folia Herniation of Encephalomeninges meningocele through a cranial defect Internal; increased Hydrocephalus CSF in ventricles caused by obstructed outflow Reproductive System Incomplete Cryptorchidism descent of one or both testes; may be ectopic Failure of Double cervix Mullerian ducts to fuse, complete or caudal portion affected
Synophthalmia
DIAGNOSIS
IN OTHER SPECIES *
Physical exam
Laryngoscopy
B,O,F,H
Physical exam
B
Physical exam
B,E,O,C,Ca,H
Physical exam Rhinoscopy
Necropsy
B,F,H
Necropsy
Necropsy
Ca,F,H
Physical exam May require exploratory surgery Vaginal exam
B,E,O,C,P,Ca,H
B
(continued)
198
JOANNE PAUL-MURPHY
Table 3.
Congenital Conditions of Llamas Classified by Body System (Continued) CONFIRMED INHERITANCE
DEFECT
Gonad hypoplasia/aplasia
Hypoplasia of vulva Phallocampsis Corkscrew curvature
Persistent frenulum Pseudohermaphrodite
Segmental aplasis of Mullerian ducts Oviduct Uterus Cervix Vagina Imperforate hymen Alimentary System Atresia ani
Atresia coli
Megaesophagus
Pyloric stenosis
DESCRIPTION
Total or partial lack of development of ovary or teste, unilateral or bilateral Infantile vulva or labia Deviation of the penis
Persistent band between ventral glans & prepuce Gonads of one sex with opposite or ambiguous genitalia
DIAGNOSIS
IN OTHER SPECIES
Rectal palpation Laparoscopy
B,O,H
Physical exam Vaginal exam Examine erect penis: may require anesthesia and electrostimulation Examination of glans penis
B B
B
Examine genitalia Hormone analysis, histology of gonads
E,O,C,P
Defective or absent development, usually unilateral, but maybe complete. May involve one or more sections
Rectal palpation Vaginal exam Ultrasonography
B,H
Anus not present, rectum ends as a blind pouch
Physical exam No feces, distended abdomen Rectal examination Contrast radiography
B,O,P,H
Segment of colon undeveloped, resulting in two blind pouches Dilation of esophagus, possible vagal nerve defect Restricted outflow from compartment 1 to duodenum
Contrast radiography (barium swallow) Laparotomy Necropsy
H
*
199
OBSTETRICS, NEONATAL CARE AND CONGENITAL CONDITIONS
Table 3.
Congenital Conditions of Llamas Classified by Body System (Continued) CONFIRMED INHERITANCE
DEFECT
DESCRIPTION
Cardiovascular System Atrial septal defect Hole in atrial septum, may have systolic murmur & split S-2 Normal fetal Patent foramen structure, may ovale stay patent 1-2 weeks after birth Persistent shunt Patent ductus from arteriosus pulmonary artery to aorta. Shunt usually from left to right, with continuous murmur Right aorta Persistent right develops aortic arch instead of left; left ductus forms a ring around esophagus, causing esophageal stenosis & regurgitation VSD, pulmonic Tetrology of Fallot stenosis, dextroaorta & right ventricle hypertrophy Opening between Ventricular septal right & left defect ventricle; holosystolic murmur Aorta arises from Transposition of right ventricle, the great pulmonary vessels artery from left ventricle. Septal defect orPDA necessary for crossHowof two circ~tions
DIAGNOSIS
IN OTHER SPECIES
*
Auscultation Echocardiography
Auscultation
Auscultation Echocardiography
Ca,H
Contrast radiography (barium swallow)
Ca
Electrocardiogram Cardiac catheterization Necropsy
Ca
Auscultation Echocardiography
B,O,Ca
Physical exam Necropsy
(continued)
200
JOANNE PAUL-MURPHY
Table 3.
Congenital Conditions of Llamas Classified by Body System (Continued) CONFIRMED INHERITANCE
DEFECT
Ophthalmic System Cataract Ectropion Entropion
Microphthalmia Distichiasis Persistent hyperplastic primary vitreous Iridal heterochromia Eyelid hypogenesis Miscellaneous Diaphragmatic hernia
Inguinal hernia
Renal aplasia
Supernumery teats Agenesis of a teat Umbilical hernia
DESCRIPTION
IN OTHER SPECIES *
DIAGNOSIS
Opacity of one or both lenses One or both eyelids everted Inversion of one or both eyelids Secondary conjunctivitis &/or keratitis common Reduced size of one or both globes Two rows of eyelashes, usually upper lid Persistence of hyloid vessels associated with posterior surface of the lens Abnormal iris color, usually blue & white; «glass eye" Reduced palpebral fissure
Ophthalmic exam
Protrusion of abdominal organs through diaphram into thorax Protrusion of abdominal organs through inguinal canal Lack of development of kidney, usually unilateral Extra teats Lack of one or more teats Defect in abdominal wall at umbilicus, usually corrects within 2-4 weeks
B,E,Ca,F,H
Ophthalmic exam Ophthalmic exam
B,O,H
Ophthalmic exam Ophthalmic exam Ophthalmic exam
Ca
Ophthalmic exam
B,P,Ca
Ophthalmic exam
H
Auscultation of chest Radiography
Ca,F,H
Physical exam
P
Rectal palpation Necropsy
H
Physical exam Physical exam
E,H
Physical exam
B,E,O,P,Ca,F
201
OBSTETRICS, NEONATAL CARE AND CONGENITAL CONDITIONS
Table 3.
Congenital Conditions of Llamas Classified by Body System (Continued) CONFIRMED INHERITANCE
DEFECT
Persistent urachus
DESCRIPTION
Allantoic stalk to bladder stays patent, may drip urine outside body or into abdomen
DIAGNOSIS
IN OTHER SPECIES
*
Physical exam Cystogram
*B = bovine; E = equine; 0 = ovine; C = caprine; P = porcine; Ca = canine; F = feline; H = human, Modified from Fowler ME: Medicine and Surgery of South American Camelids. Ames, The Iowa State University Press, 1989
SUMMARY Obstetrical care of the llama is very similar to other food animal and equine obstetrics. Understanding the few unique llama characteristics such as birthing from a standing position, no licking of the neonate by the mother, and the epidermal membrane covering the newborn, help give confidence when treating llamas. Dystocia is rare in the llama but when veterinary assistance is required, understanding the shape of the female pelvis aids in manipulations. Llama neonatal care is minimal for the healthy cria, but intensive care of a compromised cria is extremely demanding, and not always rewarding. The suggestions presented in this article are the result of 4 years' experience in providing care to many ill neonatal llamas. Several methods have been adapted from equine neonatal medicine used at the Veterinary Medical Teaching Hospital at the University of California. Basic physiological information concerning llama neonates, healthy and ill, is still being investigated. It is judicious to identify and discuss congenital problems in neonates prior to intensive support.
REFERENCES 1. Adams-Brendemuehl E, Pipers FS: Antepartum evaluations on the equine fetus. In Weir BI, Rowland IW, Allen WH, et al (eds): Equine Reproduction. IV. Proceedings of the Fourth International Symposium on Equine Reproduction. Calgary, Canada, 1986 2. Clover CK, Zarkower A: Immunologic responses in colostrum-fed and colostrum-deprived calves. Am I Vet Res 41:1002-1007, 1980 3. Fowler ME: Medicine and Surgery of South American Camelids. Ames, The Iowa State University Press, 1989 4. Garmendia AE, McGuire TC: Mechanism and isotypes involved in passive immunoglobulin transfer to the newborn alpaca (Lama pacos). Am I Vet Res 48:14651471, 1987 5. Garmendia AE, Palmer GH, DeMartini IC, et al: Failure of passive immunoglobulin
202
6. 7. 8. 9. 10. 11. 12. 13. 14.
15. 16. 17.
JOANNE PAUL-MURPHY
transfer: A major determinant of mortality in newborn alpacas (Lama pacos). Am J Vet Res 48:1472-1475, 1987 Johnson LW: Llama neonatal considerations. In Western States Veterinary Conference, Scientific Proceedings, 1988, pp 358 - 368 Jorgensen D: The significance of the development of immunity factors (IgG) in the newborn llama. Llama Association of North America, Bulletin #36 Koterba AM, Drummond WH, Kosch P: Intensive care of the neonatal foal. In Beech J (ed): Veterinary Clinics of North America (Equine Practice) Neonatal Equine Disease. Philadelphia, WB Saunders, 1985 Madigan JE (ed): Manual of Equine Neonatal Medicine. Woodland, Live Oak Publishing, 1987 Musa BE: A new epidermal membrane associated with the foetus of the camel Camelus dromedarius. Zbl Vet Med C Anat Histol Embryol 6:355-358, 1977 Naylor JM: Colostrum and passive immunity in food-producing animals. In Howard, JL (ed): Current Veterinary Therapy: Food Animal Practice. 2. Philadelphia, WB Saunders, 1986, p 99 Pfeiffer NE, McGuire TC, Bendel RB, et al: Quantitation of bovine immunoglobulins: Comparison of single radial immunodiffusion, zinc sulfate turbidity, serum electrophoresis, and refractometer methods. Am J Vet Res 38:693-698, 1977 Prescott J: Suckling behavior of llama (Lama glama glama) and Chapman's zebra (Equus burchelli antiquorum) in captivity. Appl An Ethiol 7:293-299, 1981 Rumbaugh GE, Ardans AA, Cinno D, et al: Measurement of neonatal equine immunoglobulins for assessment of colostral immunoglobulin transfer: Comparison of single radial immunodiffusion with zinc sulfate turbidity test, serum electrophoresis, refractometry for total serum protein, and the sodium-sulfite precipitation test. J Am Vet Med Assoc 172:321-325, 1978 Steven DH, Burton J, Sumar J, et al: Ultrastructural observations on the placenta of the alpaca (Lama pacos). Placenta 1:21-32, 1980 Sumar J, Novoa C, Fernandez-Baca S: Fisiologia reproductiva post-partum en la alpaca. Rev Inv Pec 1:21-27, 1972 Thomas KW, Pemberton DH: A freeze-thaw method for concentrating plasma and serum for treatment ofhypogammaglobulinemia. AJEBAK 58:133-142,1980
Department of Veterinary Medicine School of Veterinary Medicine University of California Davis, CA 95616