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3. Equine > Disease of the equine neonate > Flashcards

Disease of the equine neonate Flashcards

1
Q

“Common” diseases / conditions of the neonate

A
  • FPT
  • Sepsis/Septicemia
  • NMS
  • Meconium impaction
    <><><>
  • Uroperitoneum
  • NI
  • Gastro-intestinal ulceration
  • Angular Limb deformities
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2
Q

important history aspects to look at in a disease of the neonate case
- pertaining to pregnancy

A
  • Previous gestations
    > abortions
    > sick foals
    > neonatal Isoerythrolysis
    > normal length
    <><>
  • Diseases throughout gestation
    <><>
  • Vaginal discharge
    <><>
  • Premature lactation
    <><>
  • Dripping colostrum
    <><>
  • Vaccination history
    <><>
    gestation length
  • Normal gestation: 340 days (327-365)
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3
Q

important history aspects to look at in a disease of the neonate case
- pertaining to parturition

A
  • Attended?
  • Induced parturition?
    <><>
  • Complications?
    > dystocia
    > premature placental separation
    > early umbilical cord rupture
    > meconium staining
    > congenital abnormalities
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4
Q

what is dysmature vs premature?

A

Dysmature
* Born at term but exhibiting signs of immaturity
<><>
Premature
* Born <320 days of gestation that displays immature physical characteristics

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5
Q

characteristics of neonate immaturity

A
  • short, silky hair coat
  • pliant, floppy ears
  • domed head
  • increased passive range of motion
  • incomplete ossification of carpal and tarsal bones
  • low birth weight
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6
Q

newborn time to suckle, stand, nurse:

A

Time to suckling reflex:
* 2-20 minutes
<><>
Time to stand:
* 60 minutes
* >2 hours is abnormal
<><>
Time to nurse:
* 2 hours
* >3-4 hours is abnormal

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7
Q

type of placenta in the horse
- how are antibodies transferred?
- when?

A
  • Epitheliochorial placentation
  • All antibodies are derived from ingestion of maternal colostrum
  • Can only absorb colostrum across the gut during the first 18 - 24 hours
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8
Q

Requirements for Passive Transfer? How much colostrum should the foal drink?

A
  • Adequate colostrum production
  • Good quality colostrum
  • Adequate intake within first 18 – 24 hours (preferably within first 6 hours)
  • 20 ml/kg (1 L) in first 6 hours
  • Proper absorption
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9
Q

what should we quickly inspect to et a sense of adequate colostral production

A
  • Inspect mare’s udder
  • Premature lactation or leaking
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10
Q

colostrum quality
- IgG and Brix score

A

Very good
- >8,000mg/dl, >30%
<><>
Good
- 5000-8000, 20,30
<><>
Fair
2800-5000, 15-20
<><>
poor
<2800, <15

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11
Q

methods of assessing Passive Transfer of Maternal Antibodies
- what is gold std?

A
  • Radial immunodiffusion (gold)
  • Total protein
  • SNAP test
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12
Q

Passive Transfer of Maternal Antibodies: Assessment
- what concentration in the foal means failure, partial failure, possibly inadequate, and adequte?

A
  • <200 mg/dl
    = failure of passive transfer
    <><>
  • 200-400 mg/dl
    = partial failure
    <><>
  • 400-800 mg/dl
    = may be inadequate in high risk foals
    <><>
  • > 800 mg/dl = adequate
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13
Q

Failure of Passive Transfer: Therapy

A

Oral colostrum/plasma
* Must be within 24 hours (ideally 6) and
have normal gastrointestinal function
<><>
Intravenous plasma
* Normal/hyperimmune

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14
Q

when should a foal be nursing to ensure adequate intake of colostrum?

A

Time to nurse:
* 2 hours
* >3-4 hours is abnormal

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15
Q

what is septicemia, when does it occur? future issues?

A
  • Bacterial infection in the blood and extension to other body systems
  • Occurs when host immune defenses are inadequate to prevent invasion
  • Can localize as focal infection in the future
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16
Q

what is sepsis?
what is SIRS? trigger?

A
  • Sepsis/Septicemia: systemic inflammatory
    response to infection
    <><>
  • SIRS: Systemic inflammatory response syndrome
    > Trigger: Bacterial products (LPS), lipothenoic acid), cell death (ischemia-reperfusion injury), blunt trauma.
17
Q

Most common cause of neonatal (<7d) death?

A

Sepsis

18
Q

sepsis
- how important is it for foals?
- timing?
- prognosis?
- risk factors

A
  • Most common cause of neonatal (<7d) death.
  • Early recognition is essential!
  • Prognosis is very poor by the time a foal
    is in septic shock.
  • Risk factors:
    > prenatal infections of mare, placental abnormalities, Failure of passive transfer of maternal antibodies.
19
Q

Common Pathogens causing sepsis

A

Gram negative:
* E.coli
* Klebsiella
* Actinobacillus equuli
* Enterobacter
* Pseudomonas
* Citrobacter
<><>
* Gram positive organisms occur in ~50% of cases, but usually concurrently with a Gram negative organism

20
Q

origin of infection causing neonatal sepsis

A
  • In utero:
    > Placentitis
    > Hematogenous spread
    <><>
  • Contamination during foaling
    <><>
  • Post-foaling infection
    > Environmental contamination
    <><>
  • Risk factors
21
Q

Sepsis Score
- when should we do it?
- what is it based on?
- what does it tell us?

A
  • Should be performed on all sick neonates.
  • Based on 12 historical and clinical findings.
  • Predicts whether foal is likely to be septic.
  • NOT 100% DIAGNOSTIC. It is a diagnostic AID only.
22
Q

sepsis score information collected

A

CBC
1. neutrophil count
2. band neutrophil count
3. neutrophil toxic changes
4. fibrinogen
<><>
Other lab data
5. blood glucose
6.IgG quick test
<><>
Clinical examination
7. petechiation or scleral injection not secondary to eye disease or trauma
8. fever
9. hyponatremia, coma, depression, convulsions
10. anterior uveitis, diarrhea, resp distress, swollen joints, open wounds
<><>
Historical data
11. placentitis, vulvar discharge prior to delivery, dystocia, long transport of more, mare sick, foal induced, GI age >365d
12. Prematurity

23
Q

sepsis scoring
- PPV
- NPV
- parameters scored out of?
- what score means infection
<><>

A
  • positive predictive value: 93%
  • negative predictive value: 88%
    *each parameter scored 0-4
  • total score >11 (consistent with infection)
24
Q

lab tests for sepsis scoring

A

*low IgG, neutropenia, ­ band neutrophils (>50 bands/ml), toxic appearing neutrophils (Doehle bodies, toxic granulation, cytoplasmic vacuolization),
*hypoglycemia, and hyperfibrinogenemia.

25
Q

Supportive Care for septicemia

A

‘Routine’ foal care
* Environment
* Nutritional
* Medical Supportive
> Fluid Therapy
* Pharmacological
> Treatment
> Prevention

26
Q

Sepsis-Induced Hypotension
- what should we do

A

give fluids, but not too much

27
Q

enteral nutrition vs parenteral nutrition - which is better

A

enteral always better
- can use feeding tube
- dont overfeed
- can feed neonates milk

28
Q

antimicrobials for foal septicemia
- does it make a difference what and when we give?
- what if we combine?

A
  • yes, choice makes a difference
  • and also how quickly you start
  • combining antibiotics can lead to more susceptibility of infections to treatment
    > eg. amikacin + penicillin
    > amikacin + ampicillin
    <> both better than amikacin alone
29
Q

foal septicemia survival rates based on correct vs incorrect Abx choice

A

‘Correct’ - 65% survival
“Incorrect’ - 41% survival

30
Q

foal speticemia survival rate for:
- all types of infection
- single organism
- polymicrobial

A
  • all types of infection: 55.4% survival
  • single organism: 61.7% survival
  • polymicrobial: 40.6% survival
    <><><><>
    70% of infections are single organism
31
Q

are we getting better at treating foal speticemia vs past decades?

A

yes, survival rates are going up over time

32
Q

Neonatal encephalopathy (NE) / Neonatal maladjustment syndrome (NMS)
> common names

A

*Peripartum asphyxia
*Dummy foal
*Barker
*Wanderer

3. Equine (17 decks)

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