INTRODUCTION
There is no better diet for a neonate than the natural milk of the dam. This is why a foster mother (such as a bitch in pseudo-pregnancy) is the preferred source of nutrition for orphaned neonates. However, it could prove difficult to find a suitable infection-free bitch or queen and therefore it may be necessary to hand rear the litter using milk substitutes. It is vital that the veterinary nurse is able to advise clients accurately since the livelihood of the neonates will be at stake. It may be that you are personally involved in the undertaking of hand rearing in instances such as complications in the dam following Caesarean. In the Practical Examination, you may be required to demonstrate preparation of milk substitutes and show a good knowledge of feeding techniques and quantities to be fed.

1. In the first few hours after birth, the neonate must receive colostrum. This is a yellow viscous fluid that represents the accumulated secretions of the mammary glands over the final weeks of pregnancy. Colostrum contains high concentrations of immunoglobulins which are necessary for 90% of the new-born's passive immunity (the other 10% is derived transplacentally). Neonates need colostrum within their first few hours since immunoglobulins are large molecules which can only be taken in by pinocytosis. The small intestine ceases to absorb large molecules after a limited period. Milk substitutes do not contain colostrum, therefore it is recommended that 1-5mls of serum is obtained from the dam and injected subcutaneously into the neonate or mixed with the milk substitute and given orally. If this is not possible, deep frozen or freeze-dried colostrum from other dams may be used.
2. Commercial milk formulas are preferable to home-made milk substitutes since the exact nutritional constituents are known. They are also quicker and easier to prepare. Cimicat for kittens and Welpi for puppies are often recommended and should be made up according to the manufacturer's instructions. Using boiled water to reconstitute the milk can reduce the risk of infection. The milk should be fed at body temperature (37 °C).
3. If commercial diets are not available, home-made substitutes are acceptable. In an emergency, powdered evaporated cow's milk (made up to double the strength recommended for babies) supplemented with 8g calcium phosphate per litre is suitable for both puppies and kittens. Proprietary growth diets may be blended in a food processor and mixed with milk. Cow's milk alone is unsuitable since it contains 15% less protein than bitches milk, 30% less protein than queen's milk and half the required amount of calcium and phosphorous. Cow's milk contains significantly more lactose which can cause diarrhoea in some puppies and kittens. Other home-made diets include:
   • 3 Parts evaporated milk with 1 part water (puppies).
   • 1L Full fat cow's milk, 4 egg yolks & 1 tablespoon corn oil (puppies).
   • 800mls Cow's milk, 200mls single cream, 1 egg yolk, 6g sterilised bone flour & 4g Citric acid (puppies).
   • 500mls Cow's milk, 1 egg yolk, multivitamin drops (e.g. Abidec) & calcium supplementation (kittens).
   It is essential that the neonate receives the correct balance of calcium and phosphorous for healthy bone growth. Vitamins A and D are also of great importance. Remember however that over-supplementation can be just as harmful as too little. This is also an important factor in adult diets.
4. Having established a suitable milk substitute, a feeding regime must be organised. During the first week of life neonates require feeds every 2 hours during the day and every 4 hours at night. At 1-3 weeks of age feeds are reduced to every 4 hours during the day and every 6 hours at night. By the fourth week, feeds should be given at 8 hourly intervals.
5. There are several methods of administering the milk substitute to the neonate. Syringes are only really suitable in an emergency due to the danger of aspiration pneumonia. Orogastric or nasogastric feeding tubes are convenient but do not allow the puppy or kitten to suckle. Bottles or feeders with a nipple are ideal, but care must be taken to avoid feeding too much too quickly. Again, avoid aspiration. Hand feeding is a messy business, and if the neonate becomes wet with milk, ensure that it is cleaned, dry and warm before replacing in the incubator. It is advisable to keep the neonate wrapped in a warm towel during feeds and sensible for the nurse to wear a protective apron.
6. Puppies require 60 kcal/500g body weight per day, while kittens require 200 kcal/500g per day. Milk substitutes contain approximately 1 kcal/ml. Neonates will stop feeding when they are full. After a meal, the abdomen should feel enlarged but not distended. Never feed more than 50ml/kg in one feed if using an orogastric or nasogastric feeding tube. Puppies and kittens should gain 2-4g/kg/day of their anticipated adult body weight. Healthy neonates spend most of their time eating and sleeping. A very vocal puppy or kitten is likely to be hungry, cold or both and requires immediate attention. After a feed, gently wipe the genital area with warm wet cotton wool to simulate the action of the dam's tongue. This stimulates urination and defecation and is a very important aspect of neonate care.