Approach To The Sick Equine Neonate Flashcards
Barbera:
- 24h old filly, BAR
- 3rd foal from this mare No problems previous foals
- Parturition flawless
- Standing within 1h
- Nursing 90 minutes from birth
- Passed meconium, urinating frequently
- Vital parameters: normal for filly this age
- Measure IgG: between 400-800mg/dL
- Navel: looks ok
- Nursing well while you are there
What is your plan? (2)
- Administer hyperimmune plasma
- Disinfect navel
What should IgG levels be?
800+
What do we use to test the IgG levels?
IgG Snap Test
How do we administer plasma to a foal?
Commercial plasma is hyperimmune or form donor from same environment
Plasma administration kit (contains filter)
Thaw plasma in warm water (comfortable to hand)
- Hot water/microwave denaturate IgG!
Start slowly (10 min) checking TPR (ever 3-5 mins) then increase speed if ok until bag done
Watch for anaphylaxis:
- tachycardia, tachypnoea, fever, fasciculations, piloerection, colic, blanching of mucous membranes, collapse
RETEST IgG 24h LATER!!!
Still not okay? Need to give more. Keep going until adequate
How do we disinfect the naval?
Good practice in all foals, not only sick ones, for first few days
0.5% Chlorexedine solution superior to 2% iodine solution.
Iodine tincture of Lugol’s solution can cause necrosis and should be avoided
Care to avoid dampness or excessive dessiccation
What is this?
Patent uracus – didn’t obliterate; urine can drip and dirt go in
What is this?
Umbilical infection
Ziggy:
26 hour old colt
Quiet (still nursing), than up and down, flagging the tail, straining to defecate, some abdominal pain
Owner reports colt passed meconium at 4h
What do you do next, and in what order? (6)
- Physical exam
- Rectal (digital)
- Haematology and biochemistry
- Abdominal US
- Abdominocentesis
- Abdominal Rx+/- contrast
What best describes blood work results?.
FPT, hyperglycaemia
What would you see on bloods in sepsis which isn’t present here?
Sepsis you would have neutrophils, maybe lactate
Why is this animal not anaemic?
PCV is normal – not anaemia
What does this show?
1-2-3-4: small colon containing impacted meconium
What is this?
Diffuse gas-distended large intestine, with granular-appearing luminal contents in the caudoventral abdomen (meconium impaction).
How do you treat a meconium impaction?
ENEMA
Note:
Laxatives are pointless as the obstruction is very distal and by the time the laxative will reach the small colon you would have hoped to have cleared the impaction already.
Surgery – generally not indicated as vast majority of foals respond well to medical treatment with oenemas.
IV fluids don’t work well for impaction – just more urine
What are the 2 types of enema and how do you do them?
Oenema
- By gravity (no pressure!)
- Mix with lube/ acetylcysteine/paraffin/water
Retention oenema
•Use a ballooned catheter (Foley’s) to blockage exit of fluid introduced for 30-45minutes. When you inject in – prevents it coming out so can go further up
Do we need to give IV fluids for meconium impactions?
•IVF often not necessary as condition should resolve quickly, but if dehydration is present then appropriate
Obi-wan-cannotbe
- Full term colt
- Uncomplicated birth
- Nursing at 1h
- At 48h foal is nursing less
- HR 90bpm, RR 40bpm, Temp 39.2℃
- Skin tent ~2sec, quiet borborygmi
How would you describe these mucous membranes?
Jaundiced
Which three parameters do you think could be explain jaundice?
- PCV
- Liver enzymes
- Bilirubin
What are the two most likely diagnoses?
- Neonatal isoerythrolysis
- Sepsis
Note:
Anaemia (low pcv) from haemolysis (high bilirubin) is likely consequence of NI. Sepsis can not be discounted as foal is pyrexic and there is neutrophilia (with sepsis both neutropaenia or neutrophilia can ensue), though many with NI alone present with pyrexia and neutrophilia.
NI – mare builds AB agsinst RBC of foal. After colostrum the foal ingests the AB against the RBC. Related to ingesting IgG – get over this and the foal should be okay
Foals relying on IgG to work – IMHA needs immune function
Sepsis – anaemia and neutrophils.
How would you treat a foal where you have narrowed the differentials to NI or sepsis? (2)
- ANtimicrobial
- IVF (2x maintenance)
Why do we not give dexamethasone in NI?
Dexamethasone – although this is indicated in IMHA, in NI this is useless as the antibodies came form the colostrum and are not being actively produced. So Dex is not indicated. One may use it if the foal is in SIRS to limit the exagerated inflammatory response, however this foal does not appear in SIRS (e.g. neutrophilia and not neutropaenia)
When would we use blood transfusion in a foal?
can be used but generally only if PCV <12-15% - this foal is coping still, is more 48h old (so not absorbing more colostrum and likely as bad as it is going to get.
Why do we not use omeprazole in foals?
antacids are currently not recommended in foals as they abolish the acid barrier in the stomach and may increase the risk of infection through the GI tract
When might we use fureosemide?
may be helpful to preserve diuresis and limit kidney damage, however the effect of IVF should be sufficient for this. One might consider using furosemide generally to counteract fluid overload (not present in this foal and unlikely to develop overload if kidneys are working) but one must monitor electrolyte concentration if using furosemide.
