Abstract

Pediatric or early-age spay/neuter generally refers to the surgical sterilization of male and female dogs and cats under the traditional age of 6 months. Historically, veterinarians have been trained to wait until a dog or cat is 6 months of age before performing either an ovariohysterectomy or castration. Unfortunately, this practice does little to combat the pet and stray animal overpopulation that is found worldwide. Current research now supports the practice of pediatric spay/neuter, laying many traditionally-held fears to rest. The benefits are numerous: surgery time is much quicker, patients are awake and ambulatory typically within an hour of surgery, there are fewer peri-operative complications, and it is less expensive due to the need for fewer materials. There are several considerations, however, one should consider when performing pediatric spay/neuter procedures. Kittens and puppies should only be fasted for 2–4 hours prior to surgery to prevent the development of hyperglycemia. Supplemental heating should be administered to prevent hypothermia. Anesthetic management in the pediatric patient can be safe, provided that appropriate attention is paid to basic principles. If the procedure is performed around 3 to 4 months of age around the same time as the final puppy or kitten vaccine is administered, private practitioners do not have to worry about the client forgetting or going elsewhere for the surgery.

Overview

In most countries in Asia, there is a stray dog and cat population crisis. The World Health Organization (WHO) estimates that there are more than 200 million stray dogs worldwide. These animals are frequently subjected to inhumane culling practices, malnutrition, infectious disease, and trauma. Over 99% of human rabies fatalities are also attributed to stray dogs.

Western countries such as the USA and Canada face a different overpopulation crisis. While the number of stray dogs is minimal in many communities, millions of homeless and unwanted animals are euthanized in animal shelters. Unfortunately, the number of kittens and puppies born far outpace the number of available homes. While precise numbers are unavailable, the numbers of animals euthanized ranges from 3 to 4 million.

In an effort to actually improve animal welfare, it is recommended that resources be devoted to developing low cost spay-neuter programs. While in many communities, tackling the problem of animal overpopulation requires a multifaceted response, spaying and neutering will continue to remain a cornerstone of pet overpopulation prevention. Such reductions in population will inevitably lead to less puppies and kittens being born onto the street and less animals being relinquished to and euthanized at shelters.

There are two terms routinely used to describe sterilization procedures completed before an animal is 6 months of age: Early-age or pediatric. Early age spay/neuter typically refers to either an ovariohysterectomy or neutering procedure performed at or before 5 months of age. Pediatric spay/neuter refers to such surgery performed between 8 and 16 weeks of age.

Endorsement of Pediatric Neutering

Pediatric, or early age spay/neuter procedures have been endorsed by several national North American veterinary organizations including the Canadian Veterinary Medical Association, American Veterinary Medical Association, and the Association of Shelter Veterinarians. It is becoming increasingly more popular, particularly in high­volume spay/neuter and shelter settings. In a shelter environment, veterinarians are now encouraged to spay/neuter patients as young as 6 weeks of age.

Per the American Veterinary Medical Association:

“The AVMA supports the concept of early (prepubertal, 8 to 16 weeks of age) spay/neuter in dogs and cats in an effort to reduce the number of unwanted animals of these species. Just as for other veterinary medical and surgical procedures, veterinarians should use their best medical judgment in deciding at what age spay/neuter should be performed on individual animals.”

Commonly Cited Concerns

Commonly cited potential complications of pediatric surgery are the possibility of anesthetic or surgical complications on younger animals. Pediatric animals do indeed have higher oxygen consumption rates than adults. Therefore, younger patients must be monitored for hypoventilation. Anesthetic management in the pediatric patient can be safe, provided that appropriate attention is paid to basic principles. Pediatric cats and dog have lower body fat percentages and a larger surface-area-to-volume ratio than their adult counter parts. Their ability to shiver may also be reduced. Therefore, measures should be taken to assist pediatric patients retain body heat to avoid hypothermia. A comprehensive pre-operative physical examination should be performed on all patients.

According to the Association of Shelter Veterinarians guidelines for spay/neuter programs:

“Warmth is best preserved by reducing contact with cold surfaces, limiting body cavity exposure, and providing carefully protected contact with circulating warm water or heated containers, such as carefully monitored water bottles or rice bags. Forced hot air or convective warming can also be an effective means of maintaining body temperature peri-operatively.”¹

Alternative anesthetic protocols can help mitigate the risk involved with anesthetizing pediatric patients. It is the veterinarian’s discretion whether or not to perform diagnostics including packed cell volume, total solids, and blood glucose measurement. For most high-volume spay/neuter programs and animal shelters, such tests are cost-prohibitive.

There are various anesthetic protocols that have been designed for pediatric patients. The use of barbituates should be avoided due to limited body fat in pediatric patients.² The authors of several pediatric spay/neuter guidelines recommend the use of a dexmedetomidine, ketamine, butorphanol combination administered intramuscularly. These drugs may or may not be available in all international settings. In places where dexmedetomidine is available, atipamezole can be administered immediately after surgery to reverse the effects of the dexmedetomidine. Peri-operative analgesia should be provided in the form or a nonsteroidal anti­inflammatory such as meloxicam prior to the start of surgery.³

Also cited as a common concern is the risk of stunting of normal growth, increased risk of obesity, behavioral problems, and greater incidence of cystitis later in life. Numerous controlled studies have been performed to address these concerns. Studies have found that there is no significant weight difference between dogs and cats sterilized between 6 and 14 weeks of age and those sterilized later in life.⁴ In one study, researchers found that the limbs of animals sterilized at a young age tended to grow for a longer period of time which results in slightly taller heights.⁵ The clinical significance of this is unknown.

Special care must be taken to address pediatric patient’s susceptibility to hypothermia and hypoglycemia and small volume of blood. Minimizing fasting periods to 2 to 4 hours prior to surgery and feeding small amounts of food immediately upon anesthetic recovery can reduce such risks.⁶

Benefits

Performing pediatric spay/neuter procedures is a safer procedure and research suggests that there are no adverse physiologic effects from spaying/neutering animals prior to sexual maturity. Anecdotally, veterinarians report that pediatric spay/neuter procedures take less time to perform and have a lower risk of hemorrhage. Pediatric surgical spay/neuter techniques are similar to those for adult animals. Pediatric patients also recover much quicker from anesthesia than their adult counterparts. The surgical procedure is easier, faster, and less expensive. Shorter surgery times also mean shorter anesthetic periods, leading to reduced peri-operative complications.^7,8 The cost of pediatric spay/neuter procedures is also less than traditional surgery performed on adult patients due to the limited materials necessary.

In a shelter environment, it is recommended to spay and neuter animals as young as 6 weeks of age. In a private practice environment, veterinarians should encourage owners to schedule an additional appointment at the end of the puppy or kitten vaccination series. This way, the animal is successfully sterilized prior to 5 months of age, or sexual maturity.

References

1.  Looney AL, Bohling MW, Bushby PA. The association of shelter veterinarians veterinary medical care guidelines for spay-neuter programs. Am Vet Med Assoc. 2008;233(1):74–86.

2.  Cistola AM, Golder FJ, Levy JK, et al. Comparison of two injectable anesthetic regimes in feral cats al a large-volume spay clinic. Vet Anaesth Analg. 2003;30(2):101–102.

3.  Griffin B, DiGangi B, Bohling M. A review of neutering cats. In: August JR, ed. Consultations in Feline Internal Medicine, 6th ed. St. Louis, Mo: Elsevier Saunders; 2009:776–790.

4.  Little S. A Winn Foundation report on early spay/neuter in the cat. The Winn Feline Foundation. Cited 1 May 2017. Available at: www.nbcrtx.org/articles/catlinks_early-spay-neuter.pdf.

5.  Tremayne J. Early spay/neuter procedure: benefits must outweigh risks, DVMs say. DVM News magazine. Cited 26 April 2017. Available at: http://veterinarynews.dvm360.com/early-spayneuter-procedure-benefits-must-outweigh-risks-dvms-say.

6.  Howe LM. Prepubertal gonadectomy in dogs and cats-part I. Comp Cont Educ Pract Vet. 1999;21(2):103–111.

7.  Howe LM. Short-term results and complications of prepubertal gonadectomy in cats and dogs. J Am Vet Med Assoc. 1997;211(1):57–62.

8.  Bohling MW, Rigdon-Brestle YK, Bushby PA, et al. Veterinary seminars in spay-neuter surgeries: pediatrics (video). Humane Alliance. Cited 1 May 2017. Available at: www.youtube.com/watch?v=uvmpAQXRJg0. (VIN editor: Link not accessible).