EXPRESS: Prediction of survival in neonatal kittens using APGAR and reflex scoring.

APGAR and reflex scores are strong, practical predictors of neonatal kitten survival within four weeks of birth.

This prospective observational study evaluated the predictive value of APGAR and neonatal reflex scoring for survival outcomes in newborn kittens. Forty kittens from 11 litters were assessed within 12 hours of birth using APGAR scoring (heart rate, respiratory rate and pattern, muscle tone, reflex irritability, and mucous membrane colour) alongside three neonatal reflexes (rooting, suckling strength, and positional righting). Additional parameters included blood lactate, body weight, SpO₂, and temperature. Overall mortality was 20% (8/40) within the first four weeks of life. Cox proportional hazards modelling demonstrated that both APGAR score (HR = 0.52, P = 0.004) and reflex score (HR = 0.44, P = 0.004) were significantly associated with survival, with each one-point increase in score corresponding to a reduced hazard of death. Higher SpO₂ was independently protective (HR = 0.93, P = 0.006), while temperature and birth weight did not reach statistical significance. A significant positive correlation was identified between APGAR and reflex scores (P = 0.001). Larger litter size was associated with lower APGAR scores, reduced body temperature, and lower birth weight, highlighting litter size as a compounding risk factor. Timing of examination within the 12-hour window did not affect APGAR or reflex scores, though temperature appropriately increased with time from birth. These findings support the routine use of APGAR and reflex scoring as clinically practical, non-invasive tools for early identification of at-risk neonatal kittens requiring intervention.

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