Apgar test and plasmatic levels of glucose and lactate as viability indicators in puppies after caesarean section

Abstract

The study tried to identify whether the apgar test, plasma glucose and lactate concentration are parameters useful to determine neonatal viability and its relationship with two different anesthetic protocols (propofol vs alfaxane). Twenty-eight emergency cesarean sections were included in this study with a total of 118 neonates. Ultrasound control was performed to determine the degree of fetal stress. Immediately after birth, the Apgar test was performed to determine viability at 0 (Apgar 0), 60 (Apgar 60) and 120 minutes (Apgar 120) after the neonates were delivered. Based on the values, they were classified into three categories: critical neonates (score 0-3), neonates with moderate viability (score 4-7) and normal viability (score 8-10). Three glucose measurements were made at minute 0, at 60 minutes, and at 120 minutes and lactate was measured with blood plasma obtained from the umbilical cord. Neonatal mortality was 3.4%, once excluded neonates stillborn, with no significant difference depending on the anesthetic protocol. mean Apgar score was slightly higher (p˂0.05) in caesarean sections with alfaxane and, in both anesthetic protocols, the mean Apgar score increased with each measurement. In addition, all puppies (100%; 50/50) with alfaxane protocol showed normal viability at 120 minutes after birth, while in propofol protocol, it was observed a lower percentage (p˂0.05) of neonates with normal viability (78%; 39/50). In propofol protocol, the mean glucose levels were decreasing throughout the period assessed, while remained practically unchanged in alfaxane protocol. Lactate concentration was relatively high in both anesthetic protocols, but it was higher in those neonates with lower (critical) apgar values. Overall, the alfaxane protocol showed better results on the percentage of neonatal viability and a faster recovery of the neonates. The results showed that the Apgar test is an effective method to determine neonatal viability. Glucose was slightly elevated associated with fetal stress, with slightly differences between anesthetic protocols. The lactate concentration was higher in critical animals, so it may indicate that those neonates with a critical condition and therefore with greater cellular hypoxia, will have less viability and therefore may be an indicator of neonatal viability. Therefore, the apgar test, glucose and lactate could be considered good indicators of neonatal viability