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All breeders eagerly anticipate the birth of each alpaca cria. It is a moment in which many breeders anxiously hold their breath. Even those experienced at birthing clench their jaws in realization that it's all "on the line" with each new birth. Fortunately, alpacas have been selected for 5,000 years on the basis of unassisted birthing and will birth easily and unassisted the vast majority of times. However, the statistics of low loss nationally can change dramatically when you have a small herd. When you're expecting only two crias in a year and one dies, that's a 50% loss! Even breeders with large herds, who are more insulated from a high statistical loss due to greater numbers, have a strong financial incentive to save every baby. Without a doubt, most of us have an even stronger emotional motivation to ensure each live birth is a successful birth! There are educational articles, video tapes, lectures and seminars available to better prepare an alpaca owner for cria births. Although these are excellent aids, when it's you and the newborn alone in your barn, you need a simple method to objectively assess the well-being of your newborn.

The cria is not merely a miniature version of the adult alpaca; in many ways it closely resembles neonates of other species. "All mammalian neonates undergo a rapid change from an aquatic environment supplying total respiratory, metabolic, nutritional and thermal support, to an environmental situation where survival depends upon immediate transition to air breathing ... " [Drummond, W.H.: Proceedings from symposium, The Application of Intensive Care Therapies and Parenteral Nutrition in Large Animal Medicine. August 1986]. Thus the conscientious breeder must learn how to evaluate the newborn, recognize problems, and know what steps can be taken on the farm within those first critical minutes of life to maximize survival until professional assistance arrives.

In all neonates, the two most vital systems for immediate survival are the respiratory and circulatory systems. Should either of these systems fail to adjust to the new external environment within minutes after birth, the newborn may develop signs associated with inadequate oxygen delivery to the vital organs of the body (anoxia signs). Should the lungs fail to inflate properly due to prematurity or obstruction, there will be inadequate oxygen available to the blood for circulation. Should the heart be unable to efficiently pump blood throughout the body, or if there is a substantial loss of the cria's blood, there will be inadequate red blood cells to transport oxygen to the vital organs. Vital organs such as the brain (central nervous system), kidneys (renal system) and liver (hepatic system) would suffer from this oxygen deprivation, and life-threatening conditions would occur if immediate supportive measures are not initiated.

Anoxia to the central nervous system can cause the condition of depressed behavioral attitude with such terms, coined in other species, as "dummies," "wanderers," and neonatal maladjustment syndrome. Anoxia to the cerebrum of the brain can cause edema and hemorrhage. Signs associated with this may not appear until one to 24 hours after birth. Common observations are failure to nurse; wandering into walls (which can be associated with temporary blindness); irregular sucking or chewing movements; the inability to stand or right the body into sternal positioning; exaggerated, uncoordinated leg movements and even convulsions.

Anoxia to the kidneys or liver can be associated with the death of vital organ cells thereby preventing the removal of waste products from the blood. Unpurified blood would have increased amounts of toxins and chemicals, such as urea and acid products, which would add to the stress of the already compromised newborn.

Thus, it is of prime importance that the newborn's initial respiratory and circulatory efforts be stimulated to ensure that life-sustaining oxygen enters the lungs and is carried by the blood to cells throughout the body. The simple but important act of drying the cria may be all that is needed to stimulate respiratory reflexes and normal cardiovascular functioning. In addition, oxygen and energy stores will be conserved by the prevention of heat loss through evaporation.

Working with human babies in the early 1950s, Dr. Virginia Apgar recognized the need for a simple, standardized score which could clearly identify depressed infants requiring resuscitation or supplemental oxygen. Today, a universally accepted scoring system carries her name and is known as the APGAR score. [Apgar, V.: Proposal for a new method of evaluation of the newborn infant. Current Researches in Anesthesia and Analgesia 1953; 32:260] The score focuses on five vital signs -- heart rate, respiratory effort, muscle tone, reflex irritability and color. Each criterion is evaluated and given a numeric value of 0, 1 or 2 which is recorded at one minute and five minutes after birth. Thus, infants needing active resuscitation or supplemental oxygen are quickly and clearly identified so that they may receive optimal observation and therapy.

The Equine Neonatology Study Group from the University of Florida College of Veterinary Medicine, a multidisciplinary team, formulated a similar scoring system for foals in the early 1980s. Perhaps it was in part the recognized usefulness of APGAR scoring in humans, and the resultant reduced mortality rate, that precipitated the approach. Collectively, we began to discuss an alpaca/llama [lama] scoring system for quick and objective evaluation of newborn crias. Utilizing the original human APGAR system as well as the foal scoring system, we developed the CRIA SCORING SYSTEM.

C -- CARDIAC RATE

Compared to humans and foals, there is a paucity of research data on lama neonates. We arrived at scoring values intuitively, based on currently available information for lama neonates and our collective experiences. With continued accumulation of data, parameters distinguishing a score of 1 from a score of 2 may change. To date we have observed heart rates in alpaca neonates as high as 130 to 140, and this can be highly variable in association with the physical ability of the newborn cria. (Remember, neonatal heart rates will be considerably higher than adult rates.) It is the lower levels (less than 60 to 80 BPM) which can be problematic and are of concern.

Hear rate is determined by cardiac auscultation, using a stethoscope or by palpation. Without a stethoscope, one can hold fingers gently on either side of the chest, between the front legs, to feel the heartbeat. The axillary artery, located behind the front leg in the "armpit" may also be palpated. Using your index finger you can feel the pulsation and count the number of beats in a 15-second time period. Multiply that number of beats times four to calculate the heartbeats per minute (BPM).

R -- RESPIRATORY EFFORT

In humans, the initial respiratory rate is considered less important than the actual quality of the respiratory effort. In foals, both the nature of respiration, as well as the measured respiratory rate are used to determine the score in this category. In newborn crias we have elected not to incorporate the respiratory rate in the scoring system due to variability associated with the cria's physical activity. Instead, we focused on the nature of the respiratory efforts being made by the cria.

The neonate with no spontaneous breathing or respiratory effort scores 0. The cria whose respirations are labored, noisy or irregular, or who is gasping for breath with mouth open and nostrils flaring, scores 1; where the cria whose score is 2 shows a steady respiratory pattern.

I -- IRRITANT RESPONSE

Response to stimuli is easily assessed by gently inserting a piece of straw or stiff grass into the cria's nostril. No response to persistent intranasal tickling with the straw scores 0. The cria who grimaces, exhibiting only mild rejection scores 1. The cria who sneezes or coughs and tries to pull away or shake his head attempting to get rid of the irritant scores 2.

A -- ACTIVITY/MUSCLE TONE

Veterinarians are familiar with assessing muscle tone and could easily score on the basis of limp = 0, some tone = 1, and good tone = 2. Breeders may find activity levels as an aid in scoring muscle tone. In humans, babies with active movement or flexion or their arms and legs are rated a 2, whereas a completely flaccid infant receives a score of 0 in this category. A score of 1 denotes activity somewhere in between. A cria actively kicking and trying to achieve an upright position scores a 2, whereas the cria whose movement efforts are limited to the neck and head scores 1. A cria with minimal or no movement scores 0. We believe that evaluating erect ears at one and ten minutes after birth may not be a reliable indicator of muscle tone.

EVALUATION OF THE CRIA SCORE

In humans, the heart rate and respiratory effort are the most important factors in identifying a distressed newborn, with color of least value. In foals, mucous membrane coloration as an evaluation of oxygenation is not reliable. Since many cria have darkly pigmented mucosal surfaces, adequate evaluation of color and capillary refill cannot always be ascertained.

As in foals, the CRIA score is based on a total of four criteria assessed with a total of eight points. We discussed the inclusion of other appearance criteria, but for simplicity elected to stick to four criteria and a total of eight points. However, it may be worth noting an extra two points could be used for scoring the condition of the owner -- if in control, score 2, if shaking and hyperventilating, score 1; and if fainted, score 0.

Like the APGAR score, we have developed an objective, easily applied system of evaluating each newborn cria to 1) assess its immediate condition, 2) determine the amount of support required to provide critical life functions, and 3) evaluate the urgency in which a veterinarian is needed. Our crias are observed at one and ten minutes after parturition using the following total scores:

IMMEDIATE SUPPORTIVE ACTIONS

As soon as delivery is completed, make sure nothing is obstructing the airway passages of the nostrils or mouth. Immediately begin brisk rubbing along the cria's back and sides. Using your flattened palm, with or without a handful of straw or a dry towel, rub vigorously to stimulate the cria, as well as dry it off. Provide as much warmth as you can in these initial minutes following birth, but your priorities should be assessment of the cria's respiratory efforts and cardiac function.

We have not observed the need to force fluid from the cria's lungs by inverting the cria so that the head and neck are down, or the aggressive maneuver of "centrifuging" the baby.

With cold weather births, keep in mind that the cria has been expelled from a 100-degree Fahrenheit "oven" into a frigid environment with temperatures plummeting 60 to 100 degrees! (Birthing in below 0-degree Fahrenheit temperatures is not advised.) Preventing hypothermia is essential. In a field birth situation use your body as a windbreak. Once breathing is established, transport the cria to a sheltered area. The immediate cold weather concerns are protecting the cria from drafts and precipitation, and providing warmth in the form of deep straw bedding, dry towels, blankets or even your coat.

OXYGEN THERAPY

Should rubbing stimuli not illicit the expected normal breathing pattern, then it is paramount to provide some supportive oxygen therapy. For many owners with only a few alpacas, oxygen sources may not be available, or always needed, and the administration of artificial respiration may be all that is required.

To apply artificial respiration, the "criation attendant" can place his or her mouth over the cria's nose and mouth, gently blowing air into the newborn's lungs to provide expansion of the chest and inflation of the lungs with air. Such air will not be extremely high in oxygen, but it will allow for "opening up" the airways and air sacks (alveoli) of the lungs as well as stimulating the cria's respiratory reflexes. We suggest providing 10 to 12 breaths per minute; then stop and observe the cria's respiratory efforts for a minute to see if any additional assistance is required.

Preferably, 100% oxygen should be available for administration when large numbers of crias are expected, or where a dam has a history or expectation of a problem delivery. Oxygen systems can be arranged through your veterinarian and supplied by local medical gas supply businesses or pharmacies. An oxygen regulator will be required to administer a low flow rate. Presently for crias weighing 12 to 18 pounds (5.5 to 8.0 kg.) we are utilizing a flow rate of five liters per minute of oxygen, administered by face mask or nasal tubing.

We administer oxygen for two to five minutes to those with a CRIA score of less than 7, then repeat the CRIA scoring after a five-minute rest period. We emphasize, do not provide 100% oxygen for prolonged periods for fear of causing oxygen toxicity. With oxygen toxicity, the newborn would lack the normal carbon dioxide response required to regulate its own respiratory efforts. It is recommended that your veterinarian evaluate all crias which required initial oxygen therapy assistance.

Based on research in other neonates, the significance of prompt evaluation and treatment of oxygen deprivation will be of major importance to compromised neonates. Evaluation and treatment should not disturb the natural bonding of dam and cria.

In conclusion, this simple scoring system provides breeders with an immediate objective method to identify distressed newborns. It is a useful general prognostic tool for veterinarians in assessing the vital functions necessary to sustain life. However, even Dr. Apgar herself cautioned that the score is no substitute for a careful physical examination and close observation over the first hours of life. Her caution is well-heeded by responsible breeders who routinely observe their newborns for overall behavior, alertness and vigorous nursing in conjunction with a professional evaluation within the first 24 hours of life. All this can be done with minimal obtrusion into the natural processes, and still allow the breeder the peace of mind that comes from knowing the status of each newborn.

Figure 1. Human Apgar score is based on five signs, each scored 0, 1 or 2.

Figure 2. CRIA SCORING SYSTEM for neonates within 1 and 10 minutes of birth.

This landmark piece is copyrighted at the Library of Congress and is now being taught at veterinary schools across the country.

Copyright © 1992, Walker, Neely and Showan. All rights reserved.