Strong, Sandra Jo, et al. “Interventions and Observations Associated with Survival of Orphaned Shelter Kittens Undergoing Treatment for Diarrhea.” J Feline Med Surg, Mar. 2019. (Supported by a grant from Winn Feline Foundation and PetSmart Charities)
Diarrhea is an important and frequently encountered health problem of kittens. Over half of the deaths of kittens housed in shelters can be attributed to infectious causes of diarrhea, – mainly feline panleukopenia virus (FPV) – and many kittens fostered will die or be euthanized secondary to severe illness. Due to finite shelter resources, limited diagnostic testing is performed of orphaned kittens with diarrheal illness to identify the probable underlying cause. Thus, kittens are often treated empirically for various potential causes of gastrointestinal illness. Identification of targeted therapeutic approaches could improve the overall welfare of orphaned kittens, as well as relieve some of the burden of the shelters caring for them.
The objective of this study was to highlight associations between frequently performed or prescribed treatment interventions and survival outcome of orphaned kittens with diarrhea. The study was designed as a retrospective observational analysis, performed at a large open-intake municipal animal shelter (Wake County Animal Centre in Wake County North Carolina USA). The shelter’s typical seasonal caseload during the reproductive season (May – September) is approximately 300 kittens per month, and there are commonly 150-200 kittens in foster care during the summer annually. The kittens included in the present study were unowned, < 12 weeks of age, < 0.9 kg body weight, and relinquished between April 2016 and July 2017. Upon arrival, each kitten was administered a single dose of anti-coccidial (ponazuril), anthelminthic (pyrantel pamoate), and a topical endo-/ectoparasiticide (selamectin). Kittens > 4 wks of age and > 0.45 kg body weight vaccinated against viral rhinotracheitis, calicivirus and panleukopenia antigen. Kittens were transferred as soon as possible to a trained volunteer foster care provider.
Any kitten with diarrhea that underwent a veterinary examination at the request of the foster care provider was included in the study. The standard treatment protocol for kittens with diarrhea included ponazuril, a liquid vitamin and mineral supplement, and a probiotic supplement. Any additional treatments were performed at the discretion of the attending veterinarian, and included subcutaneous fluid administration, antibiotic treatment (oral metronidazole and/or injectable penicillin G procaine), and/or tube feeding.
Overall, 220 kittens were included in the present study. Statistical analysis of the outcomes, kitten factors (including age, weight, sex, appetite), and treatments provided was performed to identify any potential associations with survival. Of the 220 kittens presented for diarrhea, 67 (30.4%) kittens died or were euthanized due to illness. Kittens that survived were significantly older (median 7 weeks) at time of treatment for diarrhea than those that died or were euthanized (median 4 weeks). Factors that were associated with increased likelihood of survival included good appetite (odd ration [OR] 2.7), age ³4 weeks (OR 16), and body weight ³1 kg (OR 5.4).
Kittens that received a vitamin and mineral supplement (Hi-Vite Drops, Vetoquinol USA) were seven times more likely to survive than those that did not receive the supplement. There was no association between treatment with a probiotic, metronidazole, or ponazuril and survival. Kittens that received subcutaneous fluids, tube feeding, or penicillin were more likely to die or be euthanized. When controlling for age, the only independent predictors of survival identified were age ³4 weeks and vitamin and mineral supplementation. The authors propose several theories for the association between vitamin and mineral supplementation and kitten survival, including the unique nutritional requirements of cats for micronutrients including vitamins A, D and niacin, and amino acids such as arginine. At this time, how the specific nutrient requirements of kittens might change with diarrhea, if at all, are unknown.
There are several limitations and considerations for the present study, including its retrospective nature. Not all kittens underwent fecal diagnostic testing, and certain tests, such as FPV testing, was biased towards kittens that died or were euthanized prior to receiving any treatment. Moreover, there was a lack of standardized feeding protocol for kittens if foster care, and an inability therefore to determine the significance of diet on survival. Lastly, severity of diarrhea was not scored, and it is unknown whether severity or character of diarrhea may have influenced likelihood of survival.
In conclusion, the study reports a 12.8% incidence of diarrhea in orphan kittens in foster care that had previously been treated prophylactically for coccidiosis and intestinal parasites. The overall mortality rate was 11%. The authors report an increased likelihood of survival in those kittens treated with a vitamin and mineral supplement, and their findings support the incorporation of a vitamin and mineral supplement in the treatment protocols for orphan kittens with diarrhea. (HM)