Congenital hypothyroidism and dysmaturity syndrome in foals: First reported cases in Europe

Congenital hypothyroidism and dysmaturity syndrome (CHD) in neonatal foals was first described in western Canada in 1981 and remains an important problem for the western Canadian horse industry. This syndrome is characterised by hyperplasia of the thyroid gland, increased gestational length and multiple congenital musculoskeletal abnormalities. This case series describes the first confirmed cases of CHD in Europe and challenges contemporary opinion which suggests that this syndrome is distinct from congenital hypothyroidism associated with visible goitre.     

A case-control study of the congenital hypothyroidism and dysmaturity syndrome of foals.

A case-control study was conducted to identify risk factors for the congenital hypothyroidism and dysmaturity syndrome of foals. A questionnaire was used during personal interviews of foal owners and farm managers to collect information on animal signalment, farm environment, and mare management. Information on 39 foals with the congenital hypothyroidism and dysmaturity syndrome were compared with 39 control foals. Foals with the syndrome had a significantly (P < 0.0001) longer gestation (357.6 d) than control foals (338.9 d). Pregnant mares that were fed greenfeed, did not receive any supplemental mineral, left their "home farm" during gestation, or grazed irrigated pasture had 13.1 (P = 0.0068), 5.6 (P = 0.0472), 4.3 (P = 0.0076), and approximately 15.3 (P = 0.0245), respectively, greater odds of producing an affected foal than mares not experiencing these events. Greenfeed often contains high levels of nitrate (NO3-), which is known to impair thyroid gland function. In light of this, forage samples from participating farms were analyzed for nitrate levels. The odds of one or more congenitally hypothyroid and dysmature foals being born on a farm feeding forage with at least a trace of nitrate was 8.0 times greater (P = 0.0873) than the odds of the disease occurring on a farm that fed forage free of nitrate. Further, the odds of a mare producing an affected foal when fed forage containing at least a trace of nitrate were 5.9 times greater (P = 0.0007) than those of a mare fed nitrate free forage. This study suggests that congenital hypothyroidism and dysmaturity syndrome in foals may be the result of diets that contain nitrate or that are low in iodine being fed to pregnant mares.     

Evaluation of experimental methods to induce congenital hypothyroidism in guinea pigs for use in the study of congenital hypothyroidism in horses

OBJECTIVE: To develop a method to reliably induce congenital hypothyroidism in guinea pigs (Cavia porcellus) and assess similarities between the resultant developmental abnormalities and those described in horses with congenital hypothyroidism. ANIMALS: 35 female guinea pigs and their offspring. PROCEDURE: Guinea pigs were allocated to control groups or groups treated with a low-iodine diet before and throughout gestation; an s.c. injection of 100 or 200 microCi of radioactive iodine 131 (131I) on day 40 of gestation; or 0.1% propylthiouracil (PTU) continuously in the drinking water, beginning day 3 or 40 of gestation. In all groups, assessments included gestation duration, litter size, proportion of stillborn pups, and laboratory analyses in live pups and dams; postmortem examinations were performed on all pups and dams and selected tissues were examined histologically. RESULTS: Compared with control animals, pups from dams receiving a low-iodine diet or 131I s.c. had mild changes in their thyroid glands but no grossly or radiographically detectable lesions of hypothyroidism. Pups from dams receiving PTU were often stillborn (24/27 pups) and had enlarged thyroid glands (characterized by large, variably sized follicles of tall columnar epithelium and little or no colloid), an incomplete coat, and radiographically detectable skeletal dysgenesis. CONCLUSIONS AND CLINICAL RELEVANCE: Many of the lesions detected in guinea pig pups from the experimentally treated dams were similar to those described in foals with congenital hypothyroidism. Experimental induction of congenital hypothyroidism in guinea pigs may be useful for the study of naturally occurring congenital hypothyroidism in horses.     

Pharmacokinetics of an orally administered methylcellulose formulation of gallium maltolate in neonatal foals

Chaffin, M. K., Fajt, V., Martens, R. J., Arnold, C. E., Cohen, N. D., O’Conor, M., Taylor, R. J., Bernstein, L. R. Pharmacokinetics of an orally administered methylcellulose formulation of gallium maltolate in neonatal foals. J. vet. Pharmacol. Therap. doi: 10.1111/j.1365‐2885.2009.01150.x. Gallium is a trivalent semi‐metal with anti‐microbial effects because of its incorporation into crucial iron‐dependent reproductive enzyme systems. Gallium maltolate (GaM) provides significant gallium bioavailability to people and mice following oral administration and to neonatal foals following intragastric administration. To study the prophylactic and therapeutic effects of GaM against Rhodococcus equi pneumonia in foals, we developed a methylcellulose formulation of GaM (GaM‐MCF) for oral administration to neonatal foals. Normal neonatal foals were studied. Six foals received 20 mg/kg and another six foals received 40 mg/kg of GaM‐MCF orally. Serial serum samples were collected and serum gallium concentrations were determined using inductively coupled plasma mass spectroscopy. Gallium was rapidly absorbed (T_max of 4 h), and a mean C_max of 0.90 or 1.8 μg/mL was achieved in foals receiving 20 or 40 mg/kg respectively. Marked variability existed in C_max among foals: only half of the foals receiving 20 mg/kg attained serum concentrations of >0.7 μg/mL, a level suggested to be therapeutic against R. equi by previous studies. Mean elimination half‐life was 32.8 or 32.4 h for foals receiving 20 or 40 mg/kg respectively. The results of this study suggest that at least 30 mg/kg orally every 24 h should be considered in future pharmacodynamic and efficacy studies.     

Pharmacokinetics of butorphanol and evaluation of physiologic and behavioral effects after intravenous and intramuscular administration to neonatal foals

Background: Despite frequent clinical use, information about the pharmacokinetics (PK), clinical effects, and safety of butorphanol in foals is not available. Objectives: The purpose of this study was to determine the PK of butorphanol in neonatal foals after IV and IM administration; to determine whether administration of butorphanol results in physiologic or behavioral changes in neonatal foals; and to describe adverse effects associated with its use in neonatal foals. Animals: Six healthy mixed breed pony foals between 3 and 12 days of age were used. Methods: In a 3‐way crossover design, foals received butorphanol (IV and IM, at 0.05 mg/kg) and IV saline (control group). Butorphanol concentrations were determined by high‐performance liquid chromatography and analyzed using a noncompartmental PK model. Physiologic data were obtained at specified intervals after drug administration. Pedometers were used to evaluate locomotor activity. Behavioral data were obtained using a 2‐hour real‐time video recording. Results: The terminal half‐life of butorphanol was 2.1 hours and C₀ was 33.2 ± 12.1 ng/mL after IV injection. For IM injection, C_max and T_max were 20.1 ± 3.5 ng/mL and 5.9 ± 2.1 minutes, respectively. Bioavailability was 66.1 ± 11.9%. There were minimal effects on vital signs. Foals that received butorphanol spent significantly more time nursing than control foals and appeared sedated. Conclusions and Clinical Importance: The disposition of butorphanol in neonatal foals differs from that in adult horses. The main behavioral effects after butorphanol administration to neonatal foals were sedation and increased feeding behavior.     

Neurological Manifestations of Hypothyroidism: A Retrospective Study of 29 Dogs

Neuromuscular signs in association with hypothyroidism are described in 29 dogs. Eleven dogs had lower motor neuron signs, 9 had peripheral vestibular deficits, 4 had megaesophagus, and 5 had laryngeal paralysis. Primarily older (mean = 9.5 years), large-breed dogs were affected, and there was no sex or breed predisposition. Duration of clinical signs before presentation ranged from 2 to 8 weeks (mean = 5 weeks). The diagnosis was based on (1) results of neurological examination (29 dogs); (2) electromyographic abnormalities (18 dogs), including fibrillation potentials (n = 18), positive sharp waves (n = 15), and complex repetitive discharges (n = 4); (3) high serum cholesterol concentration (10 dogs; mean = 335 mg/dL); (4) low response to thyroid-stimulating hormone (29 dogs; mean T₄ prestimulation concentration = 0.8 μg/dL; mean T₄ poststimulation = 1.2 μg/dL); and (5) good response to thyroxine supplementation (26 dogs). Dogs with vestibular deficits had abnormal brainstem auditory-evoked responses (BAER), including increased latencies of P₁-P₆ and decreased amplitude of P_4,5-N₅. Seven other dogs had similar BAER abnormalities without manifesting clinical signs of vestibular involvement. Three dogs with vestibular signs had fibrillation potentials and positive sharp waves without exhibiting lower motor neuron signs. All dogs were supplemented with levothyroxine (0.02 mg/kg P0 bid). The follow-up period ranged between 6 and 30 months (mean, 14 months). Serum T₄ concentrations were measured at least 3 times for each dog every 2 months (mean T₄ concentration = 2.6 μg/dL). All but 1 dog with lower motor neuron signs and 1 dog with vestibular signs recovered after 2 months (mean, 57 days). Signs of megaesophagus became progressively less severe over 4 months. Dogs with laryngeal paralysis improved partially after 5 months. We suggest that either vestibular or lower motor neuron signs, megaesophagus, or laryngeal paralysis may be the only clinical signs of an underlying, more generalized polyneuropathy associated with hypothyroidism. Electro-diagnostic abnormalities may be detected before clinical disease develops.     

Congenital Musculoskeletal Lesions and Hyperplastic Goitre in Foals

Seven foals with multiple congenital musculoskeletal abnormalities are described. Rupture of common digital extensor tendons, forelimb contracture, and mandibular prognathism were common findings. Severe hyperplastic goitre was consistently present.     

Rupture of the gastrocnemius muscle in six foals

Rupture of the gastrocnemius muscle and subsequent disruption of the reciprocal mechanism of the hind limb was diagnosed in 6 foals examined at 7 hours to 3 weeks of age. In 2 foals, the musculoskeletal injury was detected as an ancillary finding to clinical signs of neurologic dysfunction ascribed to hypoxic ischemic insult during delivery, whereas in the other 4 foals, musculoskeletal injury, manifested as inability to rise or stand unsupported, was the chief complaint at admission. Five foals had a history of dystocia and assisted delivery. Common clinical signs were inability to rise, disruption of the reciprocal mechanism, swelling in the caudal aspect of the thigh, instability of the stifle joint, and stifle joint effusion. For mild gastrocnemius injury, exercise restriction via forced recumbency, with minimal or no bandaging, may be sufficient treatment. For more severe disruption of the muscle, limb stabilization via splinting and intensive nursing and monitoring are necessary. Four foals had important concurrent problems, including musculoskeletal deformations (joint contractures), hypoxic ischemic disease, and failure of passive transfer and associated problems (ie, sepsis, polyarthritis, and pneumonia). Moderate to severe gastrocnemius muscle injury is difficult to treat successfully, and the long-term prognosis for athletic function should be regarded as guarded.     

Interferon-gamma, interleukin-4 and interleukin-10 production by T helper cells reveals intact Th1 and regulatory TR1 cell activation and a delay of the Th2 cell response in equine neonates and foals

Cytokines produced by T helper (Th) cells are important in orchestrating the immune response during health and disease. Recent reports indicated that cytokine mRNA expression in foals is often quantitatively lower than that of adult horses suggesting that foal T cells are not fully mature. Here, peripheral blood mononuclear cells from foals and adult horses were stimulated with phorbol 12-myristate 13-acetate and analyzed for intracellular interferon-gamma (IFN-γ), interleukin-4 (IL-4) and IL-10 production, representing the Th1, Th2 and regulatory T_R1 cell phenotypes respectively, by flow cytometry. In agreement with previous reports, all three cytokines were quantitatively reduced in foals compared to adults. However, the balance between Th1 and Th2 cytokines (IFN-γ/IL-4 ratio) showed a clear Th1-biased response in foals by 6 and 12 weeks of life, while similar IFN-γ/IL-10 ratios were found in foals and adult horses. By day 5 after birth, intracellular IFN-γ production by foal CD4⁺ and CD8⁺ T cells resembled that in adults. Overall, IL-4 production was low in foals. IL-4⁺ cells peaked at day 5 of age when IL-4 was mainly produced by IgE⁺ cells. Relative percentages of IL-4⁺ Th2 cells were significantly lower in foals at all time points. The data suggested that equine neonates and young foals have an impaired Th2 response, that the immune response of foals is Th1 biased, that IFN-γ production by Th and cytotoxic T cells is qualitatively similar to adult horses, and regulatory IL-10 production by T cells is developmentally mature in foals during the first three months of life.     

Congenital hypothyroidism in a boxer dog

Congenital central hypothyroidism was diagnosed in a one-year-old boxer dog. The dog was presented for investigation of lameness, lethargy and obesity. Survey skeletal radiographs revealed delayed bone maturation and epiphyseal dysgenesis. A diagnosis of hypothyroidism was confirmed on the basis of a low basal serum thyroxine (T₄) concentration that failed to increase following bovine thyroid stimulating hormone (TSH) administration. However, repeated administration of TSH resulted in reactivation of the thyroid gland suggesting a central rather than a primary problem. Consistently low basal plasma Cortisol concentrations were suggestive of a concurrent secondary or tertiary hypoadrenocorticism. Surprisingly, plasma growth hormone concentrations were elevated before treatment but decreased once thyroid replacement therapy had commenced.     

Causes of disease and death from birth to 12 months of age in the Thoroughbred horse in Ireland

A retrospective study was carried out to investigate the causes of disease and death in a population of foals in Ireland during their first 12 months post partum. Foaling and veterinary records from 343 foals on four farms born between January 1, 2004 and May 30, 2008 were reviewed. Among 343 foals, 22 did not survive to 12 months of age. Over the five-year period, the incidence of stillbirth was 1.5% (5/343), mortality 5% (17/338) and overall morbidity was 88.5% (299/338). Morbidity was calculated to include all new conditions brought to the attention of the attending veterinary surgeon, no matter how minor. Of foals born alive: congenital abnormalities were the most common cause of death (35.3% 6/17 foals) followed by musculoskeletal trauma (5/17, 29.4%). Of 711 separate incidents of disease, 46.5% (331/711) were due to an infectious process, 25% (178/711) due to non-infectious musculoskeletal issues; and 14.9% (106/711) related to non-infectious gastrointestinal problems. Respiratory infection was the single most common disease accounting for 27.8% (178/711) of all disease incidents in this population. Findings from this study provide information regarding the causes and incidence of death and disease in the young Irish Thoroughbred population.     

Congenital Cardiac Defects in Neonatal Foals: 18 Cases (1992–2007)

Background: Literature available regarding congenital cardiac defects in foals is limited to reports of individual cases or small case series.
Objective: To describe the clinical, echocardiographic, and necropsy findings and breed predilection of congenital cardiac defects in neonatal foals.
Animals: Eighteen foals <15 days of age with 1 or more congenital cardiac defects.
Methods: Medical records of foals diagnosed with congenital cardiac defects at the William R. Pritchard Veterinary Medical Teaching Hospital were reviewed. Data collected included history, signalment, clinical signs, laboratory data, diagnostic and necropsy results, and outcome.
Results: Arabian foals represented 39% of cases with congenital cardiac defects and were significantly ( P = .004) overrepresented (OR = 4.7 [CI: 1.8–12.4]) compared with the general hospital population. Ventricular septal defect (VSD) (14/18), tetralogy of Fallot (5/18), and tricuspid valve atresia (4/18) were the most common defects identified. A ≥3/6 heart murmur (14/14) accompanied by tachycardia (14/17), tachypnea (17/17), and cyanosis of mucous membranes (7/16) were the most common clinical signs. Concurrent congenital defects were common (9/18). Two foals, both with VSD, survived for ≥ 8 years after diagnosis and 1 was a successful performance horse.
Conclusions and Clinical Relevance: Arabian horses appear to have a predisposition for cardiac defects. The presence of a loud murmur (≥ 3/6), cyanotic membranes, and tachycardia or tachypnea in a neonatal foal should warrant thorough evaluation of the heart for congenital defects. Foals with cardiac defects should be closely evaluated for concurrent congenital defects in other body systems.     

Hypercapnic respiratory acidosis: A protective or harmful strategy for critically ill newborn foals?

This paper reviews both the beneficial and adverse effects of permissive hypercapnic respiratory acidosis in critically ill newborn foals. It has been shown that partial carbon dioxide pressure (PCO₂) above the traditional safe range (hypercapnia), has beneficial effects on the physiology of the respiratory, cardiovascular, and nervous system in neonates. In human neonatal critical care medicine permissive hypercapnic acidosis is generally well-tolerated by patients and is more beneficial to their wellbeing than normal carbon dioxide (CO₂) pressure or normocapnia. Even though adverse effects of hypercapnia have been reported, especially in patients with central nervous system pathology and/or chronic infection, critical care clinicians often artificially increase PCO₂ to take advantage of its positive effects on compromised neonate tissues. This is referred to as therapeutic hypercapnia. Hypercapnic respiratory acidosis is common in critically ill newborn foals and has traditionally been considered as not beneficial. A search of online scientific databases was conducted to survey the literature on the effects of hypercapnia in neonates, with emphasis on newborn foals. The dynamic status of safety levels of PCO₂ and data on the effectiveness of different carbon dioxide levels are not available for newborn foals and should be scientifically determined. Presently, permissive hypercapnia should be implemented or tolerated cautiously in compromised newborn foals and its use should be based on relevant data from adult horses and other species.     

Enhanced or Reduced Fetal Growth Induced by Embryo Transfer Into Smaller or Larger Breeds Alters Postnatal Growth and Metabolism in Weaned Horses

Embryo transfer between breeds of different sizes impacts fetal growth in horses. We have shown that it elicits various postnatal adaptations in terms of growth and glucose metabolism until weaning. Postweaning effects remain to be described. Pony (P), saddlebred (S), and draft (D) horses were used. Control Pony-in-Pony (P-P; n = 21) and Saddlebred-in-Saddlebred (S-S; n = 28) pregnancies were obtained by artificial insemination. Enhanced and restricted pregnancies were obtained by transferring P or S embryos into D mares (Pony-in-Draft [P-D], n = 6 and Saddlebred-in-Draft [S-D], n = 8) and S embryos into P mares (Saddlebred-in-Pony [S-P], n = 6), respectively. Control and experimental foals were raised by their dams and recipient mothers, respectively and weaned on day 180. Weight gain, growth hormones, and glucose metabolism were investigated in foals between days 180 and 540. Pony-in-Draft (P-D) remained heavier than P-P on days 180, 360, and 540, with lower glucose and higher non-esterified fatty-acids on days 180, 360, and 540 and higher T₃ on day 180. Insulin sensitivity was similar between pony groups on days 200 and 540. S-P were lighter than S-D on day 180 but caught up by day 540. S-P had higher glucose than S-D on days 180, 360, and 540, as well as lower non-esterified fatty-acids and higher T₃ on day 180. Insulin sensitivity was higher in S-P than in S-D on day 200. No difference was observed between saddlebred groups thereafter. In conclusion, in horses, fetal growth is determinant for postnatal metabolism, especially for energy availability.     

A study of ossification of carpal and tarsal bones in normal and hypothyroid foals

The degree of ossification of carpal and tarsal bones was determined in normal foals of various ages and in hypothyroid and thyroidectomized foals. In normal foals ossification occurred very rapidly in the last few weeks of gestation and less rapidly from birth to 33 days. The ulnar carpal bone was consistently less ossified than other carpal or tarsal bones. Foals with congenital hyperplastic goitre had retarded ossification of the cuboidal bones, especially the central and third tarsal bones. Thyroidectomized foals had retarded ossification of lesser degree.     

Impaired local deiodination of thyroxine to triiodothyronine in dogs with symmetrical truncal alopecia

Thyroid dysfunction causes certain dermatological alterations in dogs. Insufficient delivery of thyroid hormone to the skin may originate not only from inadequate thyroid function but also from impaired local activation of thyroxine in the target organ. Thyroid parameters and deiodination were investigated in healthy dogs (group C) and in dogs with cutaneous lesions associated with hypothyroidism (group H) or with a low-T₃ syndrome (group LT). The ability of the skin to convert T₄ to T₃ was impaired in both groups H and LT but not in the controls. It is concluded that impaired local deiodination may contribute to skin problems in dogs.Abbreviations bwt body weight - DTT dithiothreitol - PBS phosphate-buffered saline (pH 7.5, 0.05 mol/L) - PTU propylthiouracyl - RIA radioimmunoassay - TRH thyrotropin-releasing hormone - TSH thyroid-stimulating hormone     

Influence of topical dexamethasone applications on insulin, glucose, thyroid hormone and cortisol levels in dogs

The influence of two topical dexamethasone applications (dermal and ototopical) on plasma insulin, glucose, thyroid hormone and cortisol levels was investigated in beagle dogs. Both treatments significantly decreased basal cortisol values, associated with exaggerated rise in insulin (∼50%), together with unchanged serum glucose levels. Dermal dexamethasone quickly decreased plasma thyroxin (T₄) levels; whereas dexamethasone in ear drops gradually inhibited time-dependently T₄ release (18–50%). Both formulations blunted plasma triiodothyronine (T₃) levels but the response induced by dermal dexamethasone was stronger than by dexamethasone ear drops. Upon drug withdrawal, insulin secretion returned to baseline a week after treatment cessation, while cortisol, T₄ and T₃ levels did not reach baseline values. These results suggest that topical glucocorticoids unexpectedly trigger secondary hypothyroidism with concomitant suppression of hypothalamic–pituitary–adrenal axis but sensitize the endocrine pancreas, thus, their application needs careful evaluation for surprisingly different effects on endocrine stress axis activity.     

The Role of Hypothyroidism in the Etiology and Progression of Dilated Cardiomyopathy in Doberman Pinschers

Background

Hypothyroidism and dilated cardiomyopathy (DCM) are both common diseases in Doberman Pinschers. A possible influence of hypothyroidism on the etiology and progression of DCM is controversial.

Objectives

Evaluation of the role of hypothyroidism in etiology and progression of DCM.

Animals

A total of 175 Doberman Pinschers.

Methods

In this longitudinal prospective study, echocardiography and 24‐hour ambulatory ECG recordings were performed in all dogs as screening tests for DCM. Total thyroxine (TT₄) and thyroid ultrasonography served as initial screening tests for hypothyroidism and low TT₄ values were followed up by a thyroid stimulating hormone (TSH) test or free total thyroxine (fT ₄)/cTSH measurements. Additionally, a follow‐up study of dogs affected by both DCM and hypothyroidism under optimal treatment for hypothyroidism was conducted.

Results

A total of 107 dogs were healthy, 45 dogs had DCM, 11 hypothyroidism, and 12 dogs had both DCM and hypothyroidism. TT ₄ values as well as the thyroid volumes were equivalent in the healthy dogs and in those with DCM. Neither ventricular premature complexes nor echocardiographic parameters differed between healthy and hypothyroid dogs. Dogs with DCM had a 2.26‐fold (CI_0.95 = 1.1–4.8) higher risk of also being affected by hypothyroidism. Despite optimal thyroid treatment of dogs with hypothyroidism and DCM, there was a progression of the heart disease.

Conclusions and Clinical Importance

This study did not confirm a role of hypothyroidism in the etiology or progression of DCM. Treatment of hypothyroidism did not improve the clinical outcome.     

Arterial blood gas parameters of normal foals born at 1500 metres elevation

Reasons for performing study: Arterial blood gas analysis is widely accepted as a diagnostic tool to assess respiratory function in neonates. To the authors' knowledge, there are no published reports of arterial blood gas parameters in normal neonatal foals at altitude. Objective: To provide information on arterial blood gas parameters of normal foals born at 1500 m elevation (Fort Collins, Colorado) in the first 48 h post partum. Hypothesis: Foals born at 1500 m will have lower P_aO₂ and P_aCO₂ than foals born at sea level due to low inspired oxygen and compensatory hyperventilation occurring at altitude. Methods: Sixteen foals were studied. Arterial blood gas analysis was performed within 1 h of foaling and subsequent samples were evaluated at 3, 6, 12, 24 and 48 h post partum. Data were compared to those previously reported in healthy foals born near sea level. Results: Mean P_aO₂ was 53.0 mmHg (7.06 kPa) within 1 h of foaling, rising to 67.5 mmHg (9.00 kPa) at 48 h post partum. P_aCO₂ was 44.1 mmHg (5.88 kPa) within one hour of foaling, falling to 38.3 mmHg (5.11 kPa) at 48 h. Both P_aO₂ and P_aCO₂ were significantly lower in foals born at 1500 m elevation than those near sea level at several time points during the first 48 h. Conclusions and potential relevance: Foals at 1500 m elevation undergo hypobaric hypoxia and compensatory hyperventilation in the first 48 h. Altitude specific normal arterial blood values are an important reference for veterinarians providing critical care to equine neonates.     

Association of Blood Lactate Concentration and Outcome in Foals

Background: Lactate concentration in blood or plasma ([LAC]) and change in [LAC] are associated with survival in sick foals. Hypothesis: [LAC] and change in [LAC] over time are associated with survival at 96 hours and discharge in neonatal foals. Furthermore [LAC] and change in [LAC] over time correlate with blood culture results and blood pressure at admission. Animals: Two hundred and twenty‐five foals consecutively admitted to a Neonatal Intensive Care Unit. Methods: Retrospective case review. Foals ≤30 days of age with [LAC] from arterial (190) or umbilical (35) blood gas analysis ([LAC]_BG) at admission, 24, and 48 hours. [LAC]_BG, blood pressure, blood culture status, and outcome (survival versus nonsurvival at 96 hours and discharge) were recorded. Change in [LAC]_BG over time ([LAC]_BGΔT) was calculated. Results: [LAC]_BG was lower in survivors (96 hours and discharge) at all times. [LAC]_BGΔT was larger for survivors (96 hours). Odds of survival (96 hours and discharge) decreased 18, 39, 53 and 22, 38, and 47%, respectively, at each sample time for every 1 mmol/L increment in [LAC]_BG and increased 156% for each 1.0/day increment in [LAC]_BGΔT from admission to 24 hours at 96 hours. Blood pressure and [LAC]_BG were not correlated (P= .196) until removal of selected foals (mean arterial pressure <60 mmHg, admission [LAC]_BG <5.5 mmol/L) (P < .001). Bacteremia was not associated with [LAC]_BG. Proposed admission [LAC]_BG cut‐points for future studies were 6.5 mmol/L (96 hours) and 5.5 mmol/L (discharge). Conclusions and Clinical Importance: Prospective studies evaluating [LAC], [LAC]_BGΔT, and cut‐points in sick foals are warranted.