Intensive care of the neonatal foal

The basic concepts of diagnosis and treatment in the abnormal neonatal foal are presented. Methods of restraint, sedation, and general nursing care are discussed, as well as more specific techniques of respiratory and circulatory system support.     

Urogenital problems in the neonatal foal

The common conditions affecting the urogenital tract of the neonatal foal and their medical and surgical management are described. Early recognition and treatment of serious abnormalities are necessary for a successful outcome in the equine neonate.     

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.     

新生犊牛抽搐症的发生与防治

牛抽搐症是新生犊牛以神经兴奋性增高和肌肉群强直性、阵发性痉挛为特征的症候群。过去该病罕见 ,近几年来 ,笔者诊治抽搐症病犊 13 4例 ,其中 1日龄 65例 ,占总病例的48 5 % ;2日龄 3 4例 ,占 2 5 4% ;3日龄 17例 ,占 12 75 % ;4～ 5日龄 14例 ,占 10 4% ;16日龄以上 4例 ,占 3 %。笔者采取综合防治措施 ,取得较好效果 ,报道如下。1　临床症状犊牛突然发病 ,常在哺乳或受到刺激时发生不同程度的抽搐。轻型 :当受惊吓时 ,机体突然发生数秒到数分种的痉挛、眩晕或呆痴 ,站立不稳 ,很快又恢复正常 ,多不引起人们的注意 ,反复发作则病情加重…     

Megavesica in a neonatal foal

A newborn male foal was diagnosed with a greatly enlarged urinary bladder (megavesica), a urinary bladder diverticulum, and a herniated and abnormal umbilical remnant. Approximately 50% of the cranial bladder including the abnormal structures was surgically resected; the foal recovered and was still asymptomatic 15 months after surgery. The aetiology of megavesica in foals is unknown but successful outcome may be achieved with surgical intervention and adequate medical support.     

Prognostic factors in the sick neonatal foal

In the foal, the most common neonatal diseases are responsible for an high non-survival rate. Since intensive care for neonatal foals is usually very expensive an early prognosis for survival at admission or during hospitalization is recommended, as well as a prognosis for future athletic potential. Therefore, prognostic factors for prematurity, septicaemia, other infectious diseases and hospitalized foals are revised and discussed on the base of literature and authors experiences. The advantages and limitations of retrospective and perspective prognostic factors is also presented, and the possible role of new expected factors deducted by the recent advances in the knowledge of main neonatal foal diseases pathogenesis proposed.     

The foramen ovale of the foetal and neonatal foal

Hearts from 24 foals were studied; 10 were from foetuses ranging in gestational age from 230 to 322 days and 14 were from newborn and young foals aged between birth and 17 days. The foramen ovale and associated vena caval and atrial structures were examined by scanning electron microscopy. Additional observations were made by light and transmission electron microscopy. A tube-like flap of tissue was observed, extending from the aperture in the caudal vena cava to the lumen of the left atrium. In the younger foetuses, the distal end of this tube was covered with a thread-like network of tissue. In animals nearer to term, the network was replaced by distal fenestrations. Protrusions were seen on the rim of the opening of the tube as it entered the atrium. The role that these may play, together with the significance of cardiac muscle and non-elastic connective tissue in the wall of the tube, were discussed with respect to possible mechanisms of closure of the foramen ovale.     

Blood gas and acid-base changes in the neonatal foal

This article reviews what are considered the basic concepts of gas transport, blood gases, and acid-base physiology is most mammalian species. Techniques for the appropriate collection of blood samples for blood gas and acid-base determinations in the newborn foal are described. Guidelines for interpretation of these values in the normal foal and those animals undergoing respiratory and metabolic derangements are provided.     

Gastrointestinal nonrotation in a neonatal foal

A 24‐hour‐old Welsh‐Thoroughbred foal presented for routine surgical repair of an abdominal and body wall hernia. The colt became acutely colicky and emergency celiotomy was performed revealing abnormal anatomical configuration of the gastrointestinal tract (GIT). Incomplete gastrointestinal rotation is a rare congenital anomaly only described in man. This report describes the clinical and diagnostic findings, surgical and medical treatment, and outcome of a neonatal foal with nonrotation of the GIT.     

Kernicterus in a neonatal foal.

A 5-day-old Thoroughbred foal was submitted to the necropsy service at the University of Kentucky Livestock Disease Diagnostic Center. The foal had a clinical history of seizure activity and severe icterus. A complete blood count and serum chemistry analysis indicated that the foal was anemic (hematocrit, 16%), hyperbilirubinemic (45 mg/dl), and hypoglycemic. At necropsy, all tissues were discolored various shades of yellow. Microscopically, there was degeneration and necrosis of cerebral neurons and cerebellar Purkinje cells; severe hepatocellular degeneration and necrosis; and deposition of amorphous golden-yellow material in the cerebellar granular cell layer, pulmonary alveoli, renal tubular epithelium, splenic trabecula, and the lamina propria of the small and large intestine. The golden-yellow material in the brain, lung, spleen, and small intestine was identified as bilirubin by histochemistry. Based on the macroscopic and microscopic findings, a diagnosis of kernicterus (bilirubin encephalopathy) was made. This report describes a rare case of equine neonatal kernicterus.     

Volvulus of the large colon in a neonatal foal

A one‐day‐old Thoroughbred colt foal was presented for assessment of abdominal pain and reduced urine output. Physical examination of the foal revealed marked abdominal distension, mild tachycardia, tachypnoea and congested mucous membranes. A marked anechoic peritoneal effusion, intestinal hypomotility and mural thickening of the large colon were detected sonographically. Serosanguinous fluid was obtained by abdominocentesis. After haemodynamic stabilisation, the foal underwent general anaesthesia and exploratory laparotomy and a 720° volvulus of the large colon at the sternal and diaphragmatic flexures was identified. After correction of the volvulus, the intraoperative findings were consistent with nonviability of the affected portion of the colon. The owner declined partial colon resection and elected for euthanasia of the foal. Although rare in neonatal foals, large colon volvulus should be considered in foals with signs of abdominal pain, abdominal distension and ultrasonographic findings of colonic mural thickening and luminal distension.     

High-frequency jet ventilation in a neonatal foal

High-frequency jet ventilation was performed on a premature foal for respiratory difficulty attributable to in utero-acquired pneumonia. The procedure involves delivery of compressed gas through a small-bore cannula at frequencies up to 400 cycles/min. Ventilation settings of drive pressure, frequency, and FIO2 were varied to optimize PaO2 and PaCO2 values. The foal was ventilated with this equipment for 14 hours. Evidence of a favorable response to this method of ventilation was observed in the form of improvement in arterial blood gas values as well as the foal's attitude and degree of respiratory effort. High-frequency jet ventilation appears to be a useful method of ventilation for respiratory disease in neonatal foals; however, there remains no clear-cut advantage over conventional positive-pressure ventilation.     

Study of the hyaloid apparatus in the neonatal thoroughbred foal

Over 80 per cent of 169 neonatal thoroughbred foals had some part of the hyaloid artery present bilaterally and its degree of completeness, colour and character was statistically symmetrical. The complete artery was present in over 60 per cent of the foals. The incidence of the hyaloid artery and its completeness, colour and character were related to the age of the foal. The hyaloid system atrophies in the early stages of the neonatal period and generally its presence did not cause any significant ocular problems. The presence and morphology of the posterior pupillary membrane was highly correlated with the presence, completeness, colour and character of the hyaloid artery.     

Hematology, blood typing, and immunology of the neonatal foal

Hematologic parameters change during the first 10 days of life. Erythrocytes increase in number but decrease in size and hemoglobin concentration. The PCV, hemoglobin, and platelet count also decrease. Total blood and plasma volume and, to lesser extent, erythrocyte volume decrease. Normal neonatal foals may have immature neutrophils (up to 5 per cent bands), and their early rapid rise in neutrophil numbers may be accompanied by a lymphopenia. Monocytes, eosinophils, and basophils are all absent or low initially. Infectious processes can cause rapid and variable changes in the leukogram. However, elevation of fibrinogen levels may lag behind the development of an inflammatory process, and this parameter should not be relied on for early evidence of infection. After 12 hours of life, there is generally a decrease in serum concentrations of Na, Cl, iron, creatinine, BUN, plasma protein, and possibly calcium. LDH, SAP, P, bilirubin, and glucose concentrations are all higher in foals than in mature horses. Creatinine may actually be elevated during the first 12 hours of life and then decreases. If azotemia, hypochloremia, hyponatremia, and hyperkalemia are found, ruptured bladder with uroperitoneum should be suspected. The creatinine concentration is preferable to BUN determination for diagnosis of this condition. Blood typing is useful for diagnosis of NI, determination of blood compatability between donor and transfusion recipient, and for verification of parentage for breed registries. Several techniques are available. Several tests are available for evaluation of the foal's immunoglobulin levels and confirmation of passive antibody transfer. Because foals suffering from FPT are more predisposed to infections, their immunoglobulin status should be determined as early as possible so that additional colostrum or plasma can be administered as needed. Neonatal isoerythrolysis is uncommon but is an important immunologic syndrome that often results in a fatal hemolytic crisis. If one suspects the condition may be likely, the optimal time for testing the mare is during the last 2 weeks of gestation. If the foal's dam is shown to have alloantibodies against a panel of known erythrocyte alloantigens, prevention is possible by feeding colostrum from another mare. If a foal develops NI, further colostrum ingestion from the dam must be prevented. Good nursing care, minimizing stress, and adequate frequent feedings are essential; prophylactic antibiotics should be used, and transfusion may be necessary.     

Transient diabetes mellitus in a neonatal Thoroughbred foal

Objective – To describe the clinical presentation, treatment, and outcome of a neonatal foal diagnosed with transient Type 1 diabetes mellitus. Case Summary – A 3‐day‐old Thoroughbred foal presented with a 24‐hour history of diarrhea and depression. Coronavirus particles were observed in the feces via electron microscopy. During hospitalization the foal developed hyperglycemia concomitantly with low insulin concentration and an adequate response to exogenous insulin therapy supported a diagnosis of Type 1 diabetes mellitus. The foal required SC insulin for 26 days, but developed complications associated with insulin therapy that resolved with appropriate care. On follow up assessment the foal was found to be a healthy euglycemic animal with normal insulin concentration at 11 months of age. New or Unique Information Provided – To our knowledge this is the first report of Type 1 diabetes in this age group and the first report of transient neonatal diabetes mellitus in horses. Type 1 diabetes mellitus should be considered a differential diagnosis for hyperglycemia in equine neonates and that it can be transient and managed successfully.     

Self-limiting subepidermal bullous disease in a neonatal foal

A 1-day-old Appaloosa colt developed vesicles/bullae involving the skin of the lips and prepuce and multiple mucous membranes. Histopathology revealed subepidermal vesicles/bullae that were clear or contained variable numbers of neutrophils and erythrocytes. The separated epidermis appeared viable. The denuded dermal papillae were often disrupted by microabscesses or coated with fibrinosuppurative debris. Fragmented basement membrane components were attached to exposed dermal papillae. Immunoperoxidase staining of sections for deposition of IgG, IgM, IgA, and C3 were positive for IgG at the basement membrane and intercellular bridges. Complete recovery ensued. The characteristics of the subepidermal bullous lesions and clinical course of lesion resolution in this foal suggested a drug-induced pathogenesis. The only known drug exposure of the foal or mare was topical application of 7% iodine to the umbilicus at the time of foaling. Similar reactions to iodine administration have been reported in humans.