Assessing Puppy Viability at Birth: APGAR and Early Risk Assessment

The first minutes after birth are critical for determining whether a puppy has adapted successfully to life outside the uterus. A puppy that appears weak, poorly responsive or unable to suckle requires prompt assessment rather than observation alone. Structured neonatal evaluation can help identify puppies that need additional support and closer monitoring during the early hours of life. 

Use the Modified APGAR Score 

Neonatal viability can be assessed using a modified APGAR score. Five parameters are evaluated: mucus membrane colour, heart rate, reflex irritability, motility and vocalization. Each parameter receives 0–2 points according to the puppy's condition¹.

Heart rate is particularly useful during the initial assessment. In the standard APGAR system, a heart rate above 220 beats per minute receives 2 points, 180–220 receives 1 point, and below 180 receives 0 points. Respiratory effort, reflex response, movement, and mucus membrane colour are assessed alongside the heart rate.

The total score helps classify the degree of neonatal distress: 

• 7–10: no distress

• 4–6: moderate distress

• 0–3: severe distress¹ 

For brachycephalic puppies delivered by cesarean section, a modified scale has been developed. A heart rate above 180 bpm receives 2 points, 120–180 bpm receives 1 point, and below 120 bpm receives 0 points, while the other parameters are scored in the same manner².

Check Neonatal Viability Reflexes 

The neonatal viability reflexes (NVR) provide another way to assess postnatal depression. The assessment focuses on the puppy's ability to search for the mammary gland and suck effectively³.

The suckling reflex can be evaluated by placing a gloved fingertip in the puppy's mouth and assessing the force of suckling. The rooting reflex can be assessed by stimulating the muzzle and observing whether the puppy actively searches. The righting reflex is evaluated by placing the puppy on its back and observing whether it can return to sternal recumbency.

NVR scores range from 0 to 6: 

• 0–2: weak viability

• 3–4: moderate viability

• 5–6: normal viability³ 

Weak reflexes may be an early indication of hypoxia. 

Assess Puppies Beyond the Score 

A transient decline in vital functions can occur immediately after birth, even in puppies delivered normally. Healthy puppies generally recover their vitality quickly. However, the first few hours remain particularly important, and puppies with APGAR scores of 0–6 require closer attention because they are more likely to have a fatal outcome within the first two hours of life³.

APGAR and NVR should therefore be considered together rather than used as the only basis for prognosis. Low scores do not invariably indicate a poor outcome, although higher neonatal mortality is more frequently associated with low scores².

Look for Congenital Abnormalities 

Every newborn should also undergo a physical examination for visible birth defects. Particular attention should be given to abnormalities such as cleft lip or palate, hernias and atresia ani.

Additional measurements can help identify puppies at increased risk. Blood glucose is useful in assessing frail neonates. Hypoglycemia below 40 mg/dL during the first eight hours of life was associated with high mortality during the first 24 hours. At 24 hours, a glucose concentration of 92 mg/dL or below was associated with increased mortality risk during the neonatal period⁴.

Umbilical cord blood lactate can provide another indication of neonatal condition because higher concentrations are associated with distressed puppies and lower concentrations with healthy, vigorous neonates⁵.

Key Takeaways 

• Perform a structured assessment of every newborn puppy immediately after birth.

• Use the modified APGAR score to assess heart rate, respiratory effort, reflex irritability, motility, vocalization and mucus colour.

• Use NVR to assess suckling, rooting and righting reflexes.

• Treat weak reflexes as a potential indicator of neonatal hypoxia.

• Puppies with low APGAR scores require closer observation and appropriate intervention.

• Check newborns for visible congenital abnormalities, including cleft lip/palate, hernia and atresia ani.

• Blood glucose and umbilical cord lactate can provide additional information when assessing puppies at increased risk.

A structured neonatal assessment gives the veterinarian a practical way to identify compromised puppies early. Combining APGAR, neonatal reflexes, physical examination and selected metabolic parameters provides a more complete assessment of immediate neonatal viability and helps determine which puppies require closer care. 

References 

1. Veronesi MC, Panzani S, Faustini M, Rota A. An Apgar scoring system for routine assessment of newborn puppy viability and short-term survival prognosis. Theriogenology. 2009 Aug 1;72(3):401-7. https://www.westie.it/apgar.pdf 

2. Uchańska O, Ochota M, Eberhardt M, Niżański W. Dead or alive? A review of perinatal factors that determine canine neonatal viability. Animals. 2022 May 30;12(11):1402. https://www.mdpi.com/2076-2615/12/11/1402 

3. Vassalo FG, Simões CR, Sudano MJ, Prestes NC, Lopes MD, Chiacchio SB, Lourenço ML. Topics in the routine assessment of newborn puppy viability. Topics in companion animal medicine. 2015 Mar 1;30(1):16-21. https://www.sciencedirect.com/science/article/pii/S1938973615000197 

4. Mila H, Grellet A, Delebarre M, Mariani C, Feugier A, Chastant-Maillard S. Monitoring of the newborn dog and prediction of neonatal mortality. Preventive Veterinary Medicine. 2017 Aug 1;143:11-20. https://www.sciencedirect.com/science/article/pii/S0167587716306468 

5. Groppetti D, Pecile A, Del Carro AP, Copley K, Minero M, Cremonesi F. Evaluation of newborn canine viability by means of umbilical vein lactate measurement, apgar score and uterine tocodynamometry. Theriogenology. 2010 Oct 15;74(7):1187-96. https://air.unimi.it/bitstream/2434/437013/4/Groppetti%20et%20al.%20post%20print.pdf