Neonate

• Most (80%) are born between 11 pm and 6 am and present with a clear light pink amnion.

  • Premature placental separation causes a red bag appearance (Allanto-chorion separates from the uterus rather than remaining attached whilst the foal breaks through the chorion) - these are emergencies as the mare and the foal are no longer exchanging oxygen
• A foal heart rate is very different from a mares, it can also be normal to hear a cardiac murmur in the first few days. These can be flow murmurs (normal blood flow heard due to the foals thin chest) or a congenital defect (which should be gone at 5 days of age). A foals heart rate peaks at 1 hour of age but remains steady at 80-100bpm for the next few days.
• It can be normal to hear crackles at the start of life, this is due to the foals lungs being filled with fluid while inside the mare and this takes a day to be absorbed into the body. They also have a higher normal temperature than mares.
• The normal foal should meet the following milestones…

  A) 5 mins

  B) 1 hour

  C) 2 hours

  D) 4 hours

  E) 4 hours

  
• The first faeces is called meconium and this is sticky and yellow.
• Owners need to apply umbilical treatment as the umbilical cord will tear and there will be remnants of the umbilical arteries and veins which create an open port from inside the foal to the outside world. At this point, it acts as a portal of entry for bacteria.

  • These naturally regress quite quickly leaving a dry stump within 24 hours.
• To minimise bacteria entry the owner should have a clean foaling environment and treat the umbilicus with an antiseptic solution. This should be used within the first four hours and the options are…

  • 0.5% chlorhexidine
  • 2% iodine
  • NOT tetracycline spray
  • Aerosolising antibiotics is not ideal (bad stewardship) and is also quite hard to do (the foal doesn’t like the noise)

  The key thing is to submerge the umbilicus completely so it can coat the entire umbilicus and the vessel remnants
• When the foal is about 12-24 hours of age the vet should perform a clinical exam and check…

  • The umbilicus
  • Nursing
  • Palate
  • Anus
  • Is there one? Has there been meconium passage?
  • Eyes
  • Chest
  • Flexural/Angular limb deformities
  • IgG concentration
  • Enema ?
  • Tetanus antitoxin injection (3.0mls IM)
  • Even if the mare has been vaccinated it is important to give a dose to the foal as there is a delay in immunity transfer
  • Placental check
• usually if there is some placenta retained then it is often the tip of the non-gravid horn
• the placenta should be a T shape when laid out and often weighs less than 6.4 kg in TB mares
• Fleet phosphate enema is typically given to Colts as they are more likely to struggle to pass meconium. This is also done to any foal where there may have been an issue with passing meconium

  • The owner may have done this but if not it is the vet's job
• Any foal that is easy to catch or doesn’t stand when you go in the box is likely unwell. If you struggle to catch the foal it is likely normal!
• label the clinical parameters

  A) crackles

  B) sytolic or continuous murmur

  C) 24

  D) 5

  E) no murmur

  F) 1

  
• When performing the clinical exam…

  • Wear gloves and change dirty gloves (particularly if contaminated with meconium/faecal matter)
  • These foals may have had inadequate colostrum transfer and have not developed their own adaptive immune response so have a high risk of infection
  • Always restrain foal in visual field of mare
  • This keeps the mare calm and hence will let her do what you need to do.
  • In some cases sedation of the mare may be necessary
  • Always restrain one arm around chest and one around bottom (or the hold onto the base of the tail)
  • Never under belly
• why should you not restrain a foal with an arm around the belly?

  this could lead to bladder rupture
• The Madigan foal squeeze mimics passage from the birth control which can cause the foal to calm down and creates a "sedative" effect. This is useful for simple procedures such as catheter placement, abdominal ultrasound and thoracic radiography. It is also part of treatment for some forms of neonatal maladjustment syndrome.
• Quiet, easy to catchy, unaware of surroundings, flat ears, no idea where the mare is and is aimlessly wandering while bumping into things are signs of neonatal maladjustment syndrome and is abnormal!
• These are the intramuscular injection sites in the foal

  • The gluteal
  • The semimembranosus and semitendinosus (the muscles that make up the hamstring muscles) this is the better site

   

  Do not use the neck musculature as neck pain/stiffness prevents nursing
• Venipuncture/ IV injections uses a 20G 1 inch needle (for most drugs) and the site of injection is the jugular vein.
• Diagnostic imaging is usually done after a squeeze or you can use sedation with benzodiazepines.

  A) bladder rupture

  B) impaction

  C) pneumonia

  D) lateral recumbency

  E) urachal remnant

  F) umbilical artery

  G) enlarged

  H) aspiration pneumonia

  
• Regardless of what has made the foal sick, if they stop nursing then that in itself creates a major problem
• A normal foal may nurse 5-6 times per hour as the capacity of their stomach is small (1L approx. in a 50kg foal) and they have minimal fat reserves but a high metabolic demand.

  • Dehydration and hypoglycaemia are common complications of systemic disease
• Nutritional support is needed in any foal that cannot nurse for more than a few hours and foals that cannot sit in sternal / have ileus require parenteral nutrition as they will not tolerate enteral nutrition.
• A foal should consume 20% of body weight in a 24 hour period (10L for 50kg foal) so your goal is 500mls/hr.
• for nutitional support place a nasogastric tube (too big to leave in place so often have to place numerous times which is not well tolerated) or an indwelling feeding tube (this is passed down the ventral meatus of the nose into the stomach, this allows the foal to feed from the mare if they wish but you can supplement what they need by gravity feeding the milk in) and start at 250ml/hr and provide the mares milk if possible or milk replacer at ¾ strength (the reduced strength decreases the risk of constipation).
• The foals that are easy to catch are likely to be obtund (abnormal mentation but responds to tactile, visual and auditory stimuli, they can be recumbent)
• state the mentation

  A) stuporous

  B) comatose

  C) responsive

  
• The main problems such as lack of suck, increased recumbency and obtund are non-specific signs and can be caused by…

  • Sepsis/SIRS
  • Enteritis
  • Pneumonia
  • Uroabdomen
  • Neonatal Encephalopathy (NE - Maladjustment syndrome)
  • Prematurity/dysmaturity
  • Neonatal Isoerythrolysis (NI)
  • Trauma
  • Musculoskeletal issues
• Assume a foal is septic unless proven otherwise as foals can have more than one problem at once! They can have subtle signs such as petechiae and abnormal mucous membranes or may not even look grossly abnormal. Most sick neonates may be suffering from sepsis or are at a very high risk of developing it.

  
• which of these IgG values indicate normal, partial and complete failure of passive transfer

  A) over 800

  B) partial

  C) complete

  
• • Hypoglycaemia is common in sick neonates. However, some degree is normal with foals in their first 1-2h. Profound hypoglycaemia occurs in sick neonates that have not nursed and these cases can quickly deteriorate. Premature and dysmature foals are more prone
  • There is a stall side test and is helpful in the field especially when referral is not an option
  • The clinical signs of hypoglycaemia is obtund +/- seizures
  • This is not a primary problem but is associated with sepsis and other clinical diseases
• Lactate is non-specific for disease but an increase suggests a severe disease process. Normal neonates have mildly increased lactate in the first 24 hrs (sometimes for up to 3 days)

  • Hence clearance of the lactate (with management/nursing and fluid therapy) may be more important than the value itself. Increases despite fluid therapy are associated with non-survival
  • There is a stall side (veterinary handheld device) test
• The normal neonate with normal renal function is hyposthenuric i.e. less than 1.008.

  • Above 1.008 can indicate renal dysfunction and/or the foal is not nursing enough
• USG can provide so much useful information. The first urination should be concentrated (hypersthenuric, over or equal to 1.030)

  • Colt should have their first urination within 8-10hrs while the filly will have theirs a bit later at 10-12hrs of age.
• • Inflammatory markers (can either use them separately or together)

  A) Serum amyloid A

  B) fibrinogen

  C) 2 to 5

  D) 12

  
• This is a proposed criteria and states that you need at least three abnormal parameters including abnormal temperature or an abnormal leukocyte count to be suspicious of SIRS.

  A) 115

  B) 5

  C) 2.5

  D) tachypnoea

  E) glucose

  
• The intensive care foal is likely to have a layer of Elastoplast around the muzzle to provide an anchor point for intranasal oxygen tubes, as well as preventing corneal ulcers from all the wires in that area.

  • This band does NOT prevent the foal from opening its mouth.
• neonatal encephalopathy (NE) is also known as neonatal maladjustment syndrome or dummy foals.
• Neonatal encephalopathy describes any neonate with (usually non-infectious) neurological signs (abnormal behaviour e.g. trying to nurse form the udder or stifle rather than the teat). These cases may have concurrent diseases so don’t forget sepsis. Most cases require intensive care and some can need more help than others and may need…

  • Colostrum via NGT
  • Feeding tube placement
  • Antimicrobials (due to the risk of sepsis or they already have sepsis)

  These can be obtunded, stuporous or comatose so can be standing or recumbent.
• fill in the blanks

  A) 320

  B) dysmature