Resuscitation and emergency management for neonatal foals.

Early intervention can dramatically alter outcome in foals. Cardio-pulmonary cerebral resuscitation can be successful and clinically worthwhile when applied to foals that arrest as part of the birthing process. Readily available equipment and an ordered plan starting with addressing the respiratory system (airway and breathing) followed by the circulatory system (circulation and drugs) are the keys to success. Hypoglycemia is common in foals that are not nursing and in septic foals. Support of serum glucose can be an important emergency treatment. Respiratory support with oxygen therapy should be considered in all foals following resuscitation and dystocia. Other foals that are likely to benefit from oxygen are those that are dyspneic, cyanotic, meconium-stained after birth,or recumbent. Emergency therapies, applied correctly, are expected to result in decreased mortality and morbidity.     

Cardiopulmonary effects and induction and recovery characteristics of isoflurane and sevoflurane in foals

OBJECTIVE: To compare induction and recovery characteristics and cardiopulmonary effects of isoflurane and sevoflurane in foals. DESIGN: Prospective crossover study. ANIMALS: 6 healthy foals. PROCEDURE: Foals were anesthetized twice (once at 1 month of age and again at 3 months of age). Anesthesia was induced by administration of the agent in oxygen through a nasotracheal tube. During maintenance of anesthesia, foals were positioned in dorsal recumbency; intermittent positive-pressure ventilation was performed. Characteristics of induction and recovery were recorded. Cardiopulmonary variables were recorded 10 minutes after anesthetic induction and 15, 30, 45, and 60 minutes later. RESULTS: All 6 foals were successfully anesthetized with isoflurane and sevoflurane. There were no significant differences between the 2 drugs in regard to characteristics of induction or recovery, and induction and recovery were generally smooth and unremarkable. There were no significant differences between drugs in regard to measured cardiopulmonary variables; however, both drugs caused initial hypotension that resolved over time. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that isoflurane and sevoflurane can both be used for general anesthesia of 1- to 3-month-old foals. Significant differences between the 2 agents were not detected for any of the variables measured, suggesting that quality of anesthesia with these 2 agents was comparable.     

Clinical investigations of halothane and isoflurane for induction and maintenance of foal anesthesia

Fifty-eight foals were divided into two groups for study of aspects of the clinical anesthetic management of foals and to characterize effects of halothane (n = 30) and isoflurane (n = 28) in foals. There were no significant differences (P greater than 0.05) in the demographics of the two groups. Results of hemograms and biochemical analysis of venous blood samples before and after anesthesia were either not influenced or only mildly (clinically unimportant) affected by either agent. Like adult horses, foals have an increased PaCO2 when anesthetized with inhaled anesthetics. We could detect no difference in the magnitude of increase in PaCO2 with either anesthetic. Anesthetic induction and recovery was most rapid with isoflurane. The quality of induction and recovery was similarly acceptable with either agent. Heart rate during isoflurane was not significantly different from conscious conditions but during halothane, heart rate was significantly less than control except at 91-120 min when statistical significance was not detected. These results support the clinical impression that foals can be safely and reliably anesthetized with either agent.     

Systemic antimicrobial therapy in foals

Antimicrobial agents are commonly used in neonatal foals for the treatment or prevention of sepsis. However, due to concerns about the development of antimicrobial resistance and increasing pressure on veterinarians to rationalise antimicrobial use, we should be trying to reduce the unnecessary use of antimicrobials. This article reviews many of the important considerations when selecting an antimicrobial for use in neonatal foals. Firstly, we consider general differences in neonatal pharmacology and physiology. Secondly, we review common antimicrobial drugs and their indications. Finally, we review antimicrobial stewardship.     

Hemorrhagic necrotizing enterocolitis associated with Clostridium difficile infection in four foals

Severe hemorrhagic necrotizing enterocolitis was determined to be the cause of death for 4 foals. Toxigenic Clostridium difficile was isolated form the intestine of each foal, and large, gram-positive, rod-shaped bacteria lined the surface of necrotic villi. This finding of toxigenic C difficile associated with enteritis in foals adds another possible cause to the list of infectious agents that should be considered when evaluating foals with enteritis. Definitive diagnosis requires a thorough diagnostic evaluation, including procedures that will identify the organism and demonstrate its toxigenicity.     

Idiopathic cecal rupture in foals after anesthesia for gastric endoscopy

Cecal rupture has been reported as a complication of tape-worm infestation or parturition in horses. Often it occurs with no apparent predisposing factors. Spontaneous rupture on the medial surface of the cecum occurred in 2 of 19 foals, 12 to 24 hours after gastric endoscopy. The sites of rupture were identical in both foals. Rupture occurred despite prior deworming, withholding of food and water before anesthesia, and care in induction of anesthesia and recovery. Surgeons should be aware of the potential of cecal rupture in horses anesthetized for elective surgery.     

Accuracy of indirect measurement of blood pressure in neonatal foals

The objectives of this study were to assess, in anesthetized neonatal foals, the accuracy of 2 automated indirect oscillometric monitors for measurement of mean arterial pressure (MAP), to determine the optimal site of cuff placement for MAP monitoring, and to determine the relationship between arterial blood pressure and cardiac output. Ten neonatal foals were anesthetized and instrumented with a catheter in the metatarsal artery for direct MAP monitoring and measurement of cardiac output by lithium dilution. Concurrent MAP measurements were obtained with Cardell and Dinamap oscillometric monitors with cuffs placed at 3 different sites (coccygeal, metatarsal, and median arteries). Blood pressure was manipulated by varying the depth of anesthesia and by administration of dobutamine or phenylephrine. A statistically significant (P = .025) interaction was found between the type of monitor and cuff placement site. With the Cardell monitor, placement of the cuff over the coccygeal artery resulted in a significantly lower bias than placement over the median or dorsal metatarsal artery (P < .0001 and P = .0149, respectively). No significant difference in bias was found with cuff placement site when using the Dinamap monitor. The correlation coefficient (r) between MAP and cardiac output was 0.47. Indirect oscillometry with a cuff placed over the coccygeal artery or dorsal metatarsal artery is an acceptable method for measuring MAP in foals. Blood pressure does not correlate well with cardiac output in anesthetized foals.     

Anesthesia in ophthalmic surgery

Ophthalmic surgical patients can be routinely anesthetized without complications if the surgeon has a thorough understanding of the effects of anesthetic agents on ocular physiology. The regulation of intraocular pressure is important for successful ophthalmic surgery and can be greatly affected by the anesthetic procedure. Agents utilized to intentionally decrease intraocular pressure are often employed for intraocular procedures. These agents have profound systemic effects that must be anticipated. Adverse drug interactions between sympathomimetic mydriatics and halogenated inhalation anesthetics also must be considered.     

Indirect oscillometric and direct blood pressure measurements in anesthetized and conscious neonatal foals

Objective: To investigate the agreement between indirect oscillometric and direct blood pressure measurement in the equine neonate. Design: Prospective observational study. Setting: University Veterinary Teaching Hospital. Animals: Ten crossbred foals of 30–46 hours of age. Interventions: Six animals (Group 1) were anesthetized. Four animals (Group 2) were restrained on a mat. All animals were instrumented with a catheter in the greater metatarsal artery and an oscillometric blood pressure cuff over the coccygeal artery. Blood pressure was varied with dobutamine, phenylephrine, nitroprusside, and increased depth of anesthesia (Group 1) or dopamine (Group 2). Measurements and main results: Simultaneous direct and indirect blood pressure measurements were obtained from the greater metatarsal artery and the coccygeal artery, respectively. There was good agreement between the 2 methods for mean and diastolic blood pressures in both groups, but not for systolic pressure. The agreement was best in mean blood pressure of anesthetized foals (mean bias –1.07; limits of agreement – 9.39, 7.25 mmHg). Conclusions: Indirect oscillometry appears to be an acceptable method for measuring mean arterial blood pressure in both anesthetized and conscious neonatal foals, and may be a valid method of monitoring critically ill foals.     

Gastrointestinal diseases of foals

Few foals escape gastrointestinal disease during the first weeks of life. Diarrhea is an extremely common problem; fortunately, however, it is usually mild and self-limiting. When it is not, the underlying cause is often an infectious agent, such as rotavirus or Salmonella spp. Our understanding of many of the infectious agents causing neonatal diarrhea is far from complete. Gastric and duodenal ulcers are a less common disease of neonatal foals. There has been an apparent increase in the incidence of ulcer disease in foals during the past few years. The most effective way of decreasing serious gastrointestinal disease in foals is through the use of good management practices. Environmental and dietary stress must be minimized, and good hygienic practices should be followed. Unfortunately, the needs of the neonate are often ignored, while attention is focused on the mare during the breeding season.     

Aspects of pharmacology in the neonatal foal

Other therapeutic agents used in foals for specific diseases are discussed elsewhere. The marked effect of species, age, and degree of maturity on drug metabolism in the neonate reinforces the danger of interspecies extrapolation of pharmacology, the need for information specific for the foal, and the necessity for monitoring drug levels in the individual. Suggested antimicrobial doses are listed in Tables 3, 4, and 6. Recommended doses of anticonvulsants and sedatives are listed in Table 8 and in the article "Intensive Care of the Neonatal Foal." The following are recommendations for drug therapy in the neonate: Avoid unnecessary administration of drug to the dam at parturition because of possible placental transfer of the drug with subsequent effects on the neonate. If possible, avoid unnecessary drug therapy in foals under 30 days of age. Select a drug that undergoes minimal biotransformation (hepatic metabolism) and is not highly protein bound. Owing to probable immunodeficiency in the neonate, broad-spectrum, bactericidal drugs are preferred for treatment of life-threatening infections. Every attempt should be made to identify the etiologic agent so that drug therapy can be based on cultures and sensitivity test results to maximize the benefit-risk ratio. Parenteral (intramuscular or intravenous) drug administration is preferable to oral. Avoid drugs that are known oxidants, which may produce hemolysis or methemoglobinemia. In general, the same or a slightly higher initial dose should be employed in the neonate, but it should be given less frequently than in the adult if it has a high potential to cause toxicity. When possible, individual monitoring of serum levels of potentially toxic drugs should be employed in premature and newborn foals unless specific drug pharmacokinetics are known for that age group.     

Surgical Correction of Uterine Torsion and Mare–Foal Survival in Advance Pregnant Equine Patients

This article describes the surgical management of uterine torsion by midline celiotomy and cesarean section on 12 mares presented with signs of colic to a teaching veterinary hospital. The mares were either in full term of gestation (n = 7) or in advanced stage of pregnancy (n = 5). Six mares were in first parity. Uterine torsion was diagnosed by per rectal and per vaginal examinations. For surgical intervention, mares were anesthetized using a combination of xylazine (1.1 mg/kg) and ketamine (2.2 mg/kg), intravenously. After intubation, the animals were maintained on halothane (n = 4) or isoflurane (n = 8) inhalation anesthesia. Midline celiotomy was performed, and foals were delivered by cesarean section. In 11 mares, before closing the abdominal wound, the uterus was detorted manually and confirmed for its normal position. Both anesthetic protocols using halothane and isoflurane were found satisfactory for surgical correction of uterine torsion. After long-term follow-up, the study reported 75.0% (9/12) survival rate for mares. One mare was euthanized because of devitalized, necrosed, and adhered uterus to the abdominal wall. Of the nine surviving mares, seven were successfully bred. Three foals were born alive, and only one could survive on long-term basis. Of the nine dead foals, two had umbilical cord torsion.     

Repetitive stimulation of the common peroneal nerve as a diagnostic aid for botulism in foals

Background: Botulism is a potentially fatal paralytic disorder for which definitive diagnosis is difficult. Objectives: To determine if repetitive stimulation of the common peroneal nerve will aid in the diagnosis of botulism in foals. Animals: Four control and 3 affected foals. Methods: Validation of the test in healthy foals for its comparison in foals with suspected botulism. Controls were anesthetized and affected foals were sedated to avoid risks of anesthesia. The common peroneal nerve was chosen for its superficial location and easy access. Stimulating electrodes were placed along the common peroneal nerve. For recording, the active and reference electrodes were positioned over the midpoint and distal end of the extensor digitorum longus muscle, respectively. Repeated supramaximal stimulation of the nerve was performed utilizing a range of frequencies (1–50 Hz). Data analysis consisted of measuring the amplitude and area under the curve for each M wave and converting these values into percentages of decrement or increment based on the comparison of subsequent potentials to the initial one (baseline) within each set. Results: A decremental response was seen at all frequencies in control foals. Decremental responses also were observed in affected foals at low frequencies. An incremental response was seen in all affected foals at 50 Hz. Conclusions and Clinical Importance: Decreased baseline M wave amplitudes with incremental responses at high rates are supportive of botulism. Repetitive nerve stimulation is a safe, simple, fast, and noninvasive technique that can aid in the diagnosis of suspected botulism in foals.     

Uveal Inflammation in Septic Newborn Foals

Background: Septicemia in humans is described as a leading cause of uveitis, which eventually can induce blindness. Hypothesis/Objectives: Uveal inflammatory findings could be related to sepsis severity in newborn foals and might be used as an indirect indicator for survival. Animals: Seventy‐four septic foals, 54 nonseptic foals, and 42 healthy foals. Methods: Prospective observational clinical study. A detailed blinded, ophthalmic examination was performed by boarded ophthalmologists on all admitted newborn foals. Foals were grouped as septic (when blood culture resulted positive or the sepsis score was ≥14), nonseptic, and controls. Based on blood culture results, the septic group was subdivided into bacteremic and nonbacteremic foals. Results: Blood culture was performed in 62/74 septic foals, from which 35 (56%) were bacteremic and 27 (44%) were nonbacteremic. Anterior uveitis was diagnosed in a significantly (P < .005) higher number of septic/bacteremic foals (14/35, 40%) than in septic/nonbacteremic foals (5/27, 19%), nonseptic foals (4/54, 7%), and control foals (0%). Anterior chamber fibrin was only observed in 4/14 (29%) septic/bacteremic foals with anterior uveitis. Anterior uveitis was also associated with posterior uveitis in 6/35 (19%) septic/bacteremic foals. The diagnosis of uveitis was related to nonsurvival (P= .001, odds ratio = 6.2, 95% confidence interval = 2.1–18.2). Conclusions and Clinical Importance: Anterior uveitis is highly prevalent in septic newborn foals, especially in those with a positive blood culture, and it should be considered as a survival prognostic factor.     

A comparative analysis of the acoustic structure of separation calls of Mongolian wild horses (Equus ferus przewalskii) and domestic horses (Equus caballus)

In equines, calls given by foals or mothers when they are seeking contact with each other or by stallions seeking contact with other group members could be classified as affiliative or separation calls when a reunion follows the vocalizations. To investigate how domestication can affect the characteristics of vocalizations produced by equines, separation calls produced by Przewalski's (Przw) horses and Mongolian domestic horses (MDH) living in the same habitat were recorded, spectrally analyzed, and compared. Species-specific acoustic differences were found in the separation vocalizations of mares and foals. In particular, the second and third formants of the calls emitted by Przw mothers were significantly higher in frequency than those emitted by Mongolian domestic mothers, whereas the same acoustical variables were significantly lower in Przw foals than Mongolian domestic foals. Second and third formants have a significant effect on discriminating separation calls emitted by mares and foals from these different equine species. With the exception of the duration of the call, no significant species-specific differences in acoustic parameters were observed in separation calls emitted by stallions. Bioacoustic analysis can discriminate 2 different species that can be affected by their environment, evolution, and social organization.     

Thoracic trauma in newborn foals

In a report describing life ending fractures (255 horses) from the Livestock Disease Diagnostic Center, Kentucky (1993 and 1994), 32 foals had rib fractures. The purpose of our study was to examine the incidence of rib fractures in newborn foals on a Thoroughbred studfarm by physical and radiographic examination, to determine factors which may contribute to the problem and to document any clinical consequences. All foals (263) included were examined within 3 days of birth. The thoracic cage was palpated externally for abnormalities and all foals were placed in dorsal recumbency to evaluate thoracic cage symmetry. Radiographs were used to diagnose foals with thoracic cage asymmetry (TCA) and rib fracture (RF). A diagnosis of costochondral dislocation (CD) was made when no radiographic evidence of fracture was present but there was severe TCA. Fifty-five foals (20.1%) had TCA (9 RF). One to 5 ribs were fractured on 9 of 40 radiographic studies. No consequences of the thoracic trauma was detected clinically, radiographically or ultrasonographically in this group of foals or at a 2- and 4-week follow-up examination. The percentage of foals with a history of abnormal parturition was higher in the TCA foals (15%) compared to the normal foals (6.8%). There were more primiparous dams in the TCA group than in the normal foal group. Fillies (56.6%) had a higher incidence of birth trauma than colts (43.4%). This study demonstrates that thoracic trauma is often present in newborn foals and may not always be of clinical significance. Dystocia foals and foals from primiparous mares should be considered high risk for thoracic trauma.     

Serum opsonization capacity, phagocytosis, and oxidative burst activity in neonatal foals in the intensive care unit

BACKGROUND: Phagocytic activity of neonatal foals has been reported to be similar to that of adult horses, but serum opsonization capacity develops with age and may be further altered when opsonins are consumed during infection. HYPOTHESIS: Phagocytosis, oxidative burst activity, and serum opsonization capacity in neonatal foals admitted to an intensive care unit are reduced in comparison with control foals. ANIMALS: Blood samples were collected from hospitalized neonatal foals and from control foals. Hospitalized foals were characterized as sick or septic on the basis of a sepsis score and received intravenous plasma transfusion. METHODS: Phagocytosis, oxidative burst activity, and serum opsonization capacity were tested with flow cytometric analysis. Serum immunoglobulin and complement component 3 concentrations were determined with radial immunodiffusion. Serum amyloid A concentration was assayed with a commercially available solid-phase Sandwich ELISA Kit. Data were analyzed with nonparametric and regression methods. Alpha was set at P = .05. RESULTS: Phagocytic functions of septic and sick foals were lower than control foals in the initial phase of the study (P = .01). Opsonization capacity was significantly higher when bacteria were opsonized with serum from septic (P = .029) and sick (P = .006) foals than from control foals on day 1. Opsonization capacity in septic foals was comparable with control foals on days 2 and 5. This effect was not accompanied by an increase in serum complement C3 or immunoglobulin G concentrations independently. CONCLUSIONS AND CLINICAL IMPORTANCE: Our results suggest that phagocytic function could be decreased in hospitalized foals. The synergistic effect of opsonic elements provided by plasma transfusion may sustain opsonization capacity during sepsis.     

Study of serum amyloid A concentrations as a means of achieving early diagnosis of Rhodococcus equi pneumonia

REASONS FOR PERFORMING STUDY: Prognosis of Rhodococcus equi pneumonia can be challenging because the course of the disease is often insidious and overt clinical signs are subtle. Early diagnosis is considered desirable because it may offer the chance of more successful implementation of treatment and, thereby, improved outcome. Serological tests have previously failed to be accurate for early detection or diagnosis. Measurement of serum amyloid A (SAA) prior to and at the time of clinical signs was therefore chosen in order to assess its potential clinical use. OBJECTIVE: To determine whether SAA concentrations differentiate foals affected with R. equi pneumonia from unaffected foals, either prior to the onset of disease or at the time of onset of clinical signs. HYPOTHESIS: SAA concentrations are significantly higher among foals that develop R. equi pneumonia than in foals from the same environment that remain clinically unaffected. METHODS: Serum samples were obtained from 212 foals 7-14 days and 196 foals 21-28 days post partum, and from affected foals and age-matched controls at the time of onset of signs of pneumonia. SAA concentration was determined for each sample. RESULTS: There were no significant differences between SAA concentrations of foals with R. equi and clinically unaffected foals during the 2 periods of examination or at the time of onset of clinical signs of R. equi pneumonia. CONCLUSIONS: Concentrations of SAA are variable among foals with R. equi pneumonia and cannot be used reliably either as an ancillary diagnostic tool or to screen for early detection of disease during the first month post partum. POTENTIAL RELEVANCE: Bimonthly monitoring concentration of SAA is not useful as a screening test for early detection of R. equi pneumonia and does not facilitate diagnosis of this disease when used according to the protocol of this study.     

Determination of cardiac output in neonatal foals by ultrasound velocity dilution and its comparison to the lithium dilution method

Objective – To compare cardiac output (CO) measured by use of lithium dilution (LiDCO) and ultrasound velocity dilution (UDCO) in conditions of high, intermediate, and low CO in anesthetized foals.
Design – Original prospective study.
Setting – University teaching hospital.
Animals – Six foals 1–3 days of age (38–45 kg).
Interventions – Neonatal foals were anesthetized and instrumented to measure direct blood pressure, heart rate, arterial blood gases, and CO. The CO was measured by use of LiDCO and UDCO techniques. Measurements were obtained from each foal at baseline and during low, intermediate, and high CO states. Measurements were converted to cardiac index (cardiac index=CO/body weight) values for statistical analysis. Agreement between the 2 methods was determined using Bland and Altman analysis and concordance correlation coefficients.
Measurements and Main Results – LiDCO determinations of CO ranged between 4.0 and 14.0 L/min resulting in cardiac index ranging between 75.5 and 310 mL/kg/min. There was no significant effect of blood pressure variation on bias or relative bias ( P =0.62 and 0.93, respectively). The mean bias and relative bias of UDCO (±SD) compared with LiDCO were −20.1±39.2 mL/kg/min and −7.7±23.4%, respectively. Concordance correlation coefficient between LiDCO and UDCO was 0.833.
Conclusions – When compared with LiDCO, the UDCO technique has acceptable clinical utility for measuring CO in healthy anesthetized newborn foals.     

A preliminary investigation of the use of a foal image to reduce mare stress during mare–foal separation

The data for this study were collected from 7 mares (10 ± 1.6 years old) when their foals were 4-, 15-, 30-, 45-, or 60-days-old. On each occasion, the foals were anesthetized and placed out of sight of the mare and the mares’ behavior, heart rate, and cortisol response to foal separation in either the presence of a foal phantom, a square shape, or no visual stimuli were measured. In the presence of the foal phantom, anxious (P = 0.119) and agitated (P = 0.524) mare behavior was not significantly different from baseline values. The mares had significantly elevated behavior scores for 5 out of 6 criteria when the square phantom was presented and were significantly more active (higher scores for fidgety and active criteria) when no visual stimuli (control) were provided. Based on the data presented in this study, the use of a phantom image of a foal with neutral ear and tail position may be an effective nonchemical method of calming mares during separation from their foal.