Equine Neonatal Flashcards
how long should stage 1 of foaling last?
30-60 minutes
what signs are seen during stage 1 of foaling?
restlessness
coliky
what happens during stage 1 of foaling?
cervix relaxation
uterine contractions
what happens at the end of stage 1 of foaling?
rupture of chorioallantois (waters break)
how long does stage 2 of foaling last?
5-30 mins
what should happen during stage 2 of foaling?
delivery of foal
what is critical about stage 2 of foaling?
must not be longer than 30 mins
how long does stage 3 of foaling last?
2-3 hours
what happens during stage 3 of foaling?
placental (foetal membranes) expelled
what is necessary if stage 3 of foaling is delayed?
assistance
how soon after birth should foals be standing?
1 hour - may be a little wobbly
how long after birth should foals suckle?
within 2 hours - may take time to find udder
what should be checked for once foals start to feed?
milk at nostrils
how soon after birth should foals pass meconium?
within 3 hours
how soon after birth should foals urinate?
8-12 hours
what may effect how quickly foals urinate after birth?
colts may urinate earlier than fillies
how do healthy foals sleep?
legs extended in lateral
is foals sleeping with limbs curled up normal?
no - indicates something is wrong
what would be heard on lung auscultation of foals immediately after birth?
audible crackles
what RR is seen in newborn foals?
50-80 brpm
when will foals respiratory parameters get closer to normal?
within 2-3 hours of birth
what may be seen at foals nostrils immediately following birth?
mild nasal discharge
what is the normal HR for foals up to 7 days old?
80-100 bpm
what is the normal RR for foals up to 7 days old?
30-40 brpm
what is the normal temperature for foals up to 7 days old?
37.5-39.5 degrees C
what do normal MM look like for foals up to 7 days old?
pink and moist
what is the normal PQ for foals up to 7 days old?
good
warm extremities
what is the normal BP for foals up to 7 days old?
> 70 mmHg
how much colostrum do foals require in the first 24 hours?
1L
how much on average will a foal drink per day?
20-30% of body weight
how many calories do foals require per day?
100-160 kCal/kg/day
what is essential about colostrum?
contains antibodies from the mares blood which are absorbed by the foals gut
what is passive transfer?
antibodies from the mares blood which are absorbed by the foals gut through colostrum
how long does passive transfer last for?
12-24 hours after birth
what is the concentration of foals urine like?
very dilute
what can go wrong during birth?
trauma during birth
congenital abnormalities
acquired abnormalities
failure of passive transfer
what can cause trauma during birth?
dystocia
what trauma to the foal is commonly seen following dystocia?
rib fractures
what are some of the congenital abnormalities seen in foals?
cleft palate
microphthalmia
limb deformities
what acquired abnormalities may be seen in foals?
patent urachus
how can patent urachus be identified?
urine from umbilicus on urination
what can cause failure of passive transfer?
foal unable to drink
quality or quantity of colostrum poor
what is sepsis usually caused by?
failure of passive transfer
infection (usually umbilicus)
what is sepsis?
inflammatory response to systemic bacteria
what are the clinical signs of sepsis?
pyrexia
petechiae
injected MM
dull/flat
recumbent
what may be seen with concurrently with sepsis?
uveitis
synovial sepsis
diarrhoea
pneumonia
umbilical infection
what is the most common reason for diarrhoea in foals?
sepsis
what effect does sepsis have on BP?
hypotension
what are the signs of neonatal isoerythrolysis?
anaemia
icterus
weakness
what happens during neonatal isoerythrolysis?
mare produces antibodies against foals RBCs
foal absorbs colostrum and so has antibodies against own RBCs
own RBCs are then broken down by these antibodies
what can cause a mare to produce antibodies against the foals RBCs?
previous foal with the same sire
contact with foal RBC during delivary
how is neonatal isoerythrolysis treated?
separate nutrition from the mare until no more antibodies will be absorbed (24hours after birth)
supportive care until own RBC regenerate
what is neonatal maladjustment syndrome also known as?
hypoxaemic ischemia encephalopathy
perinatal asphyxia syndrome
dummy foal
what body system is mostly affected by neonatal maladjustment syndrome?
neuro
what is the clinical presentation of neonatal maladjustment syndrome?
variable
poor suck reflex
failure to nurse
hyperaesthesia
obtundation
coma
when will signs of neonatal maladjustment syndrome be seen?
abnormal from birth
may be normal from birth and then crash at 24-48 hours
how is neonatal maladjustment syndrome treated?
supportive care
foal squeeze (limited evidence)
what makes a foal premature?
<320 days gestation
what makes a foal dysmature?
normal gestation but appear premature
what are the signs of premature and dysmature foals?
silky coat
floppy ears
lax tendons
domed head
immaturity of other organs
incomplete ossification of cuboidal bones
why are cuboidal bones most affected by prematurity/dysmaturity?
last to mature
how can premature/dysmature foals be managed?
x-ray to assess cuboidal bones
foal kept in recumbancy to preserve bones
what can happen in premature/dysmature foals with incomplete ossification of cuboidal bones?
bones crushed when weightbearing
what can cause a ruptured bladder in foals?
trauma during birth
handling under the abdomen
when are clinical signs of bladder rupture seen?
afew days after birth
what are the signs of ruptured bladder?
colic
abdominal distension
why is a ruptured bladder life threatening?
electrolyte abnormalities caused
what electrolyte abnormalities are caused by bladder rupture?
hyperkalaemia
hyponatraemia
hypochloramia
how should foals be moved?
using stifles and forelimbs
never from abdomen
how soon after birth is meconium passed?
within 3 hours
what are the clinical signs of meconium impaction?
straining to defecate
mild colic
what may foals with meconium be referred to hospital for?
IVFT
management
what are the roles of the NICU nurse?
patient care
provide for foals needs
stay organised
keep foal unit cleaned and stocked
communication with team
care for mare
what is involved in the general nursing care of foals in the NICU?
maintain sternal recumbency
assist to stand
turn every 2 hours
weigh daily
careful exam
why should foals stay in sternal recumbency?
prone to atelectasis and so reduced oxygenation
how often should foals be assisted to stand?
every 2 hours to nurse
why is it important that foals are turned every 2 hours?
prevention of decubital ulcers
what is involved in the NICU exam?
demenour compared to last check
nose to tail
assess treatments
nutrition needs
urine and faecal output
how may foals urine output be managed?
U cath (preventio of scauld)
how often should sick foals be examined?
every 4 hours but may be every 2
how can foals CVS be assessed?
MM
CRT
HR
what is indicated by MM?
systemic health
where can MM be checked on the body?
buccal
conjuctiva
ear pinnae
coronary band
what is normal HR for foals?
80-100 bpm
what do foals rely on for cardiac output?
stable HR as unable to increase stroke volume
why is HR compensation in foals so poor?
immature sympathetic nervous system exacerbated by hypotension and poor perfusion
what is commonly heard on auscultation of foals under 4 days old?
murmurs
how long should murmurs caused by adaption to life ex utero be heard for in foals?
only up to 4 days
what is the normal range for RR seen in foals?
30-40 brmpm
what may be heard on auscultation of foals lungs?
louder bronchial sounds than adults
wheezing only in first few hours of birth
what should be assessed about foals RR?
rhythm
bronchial sounds
wheezes/crackles
effort
discharge
have there been rib fractures
how can oxygenation be assessed?
blood gas
what about the eyes may indicate dehydration?
sunken eyes
entropian
what about the eyes may indicate sepsis?
injected MM
hypopyon
uveitis
what is hypopyon?
fibrin and pus accumulation within anterior chamber of the eye
what may indicate trauma around the eyes?
injected MM
swollen eyelids
what are sick foals prone to developing in the eyes?
corneal ulcers
why are foals more prone to developing corneal ulcers?
reduced corneal sensitivity so they may go untreated
what should the foals MSK system be assessed for?
septic joints
osteomyelitis
incomplete ossification of cuboidal bones
flexural deformities
angular limb deformity
how can the foal be checked for presence of septic joints?
joints checked at each check
no lameness
what flexural deformities may be seen?
flexor or tendon laxity
contracture
what direction are flexural deformities seen?
dorsal/ palmar or plantar
what may cause colic in foals?
meconium impaction
atresia ani
ileus
why is diarrhoea seen in foals?
secondary to sepsis if very young
acquired infectious diarrhoea
what solution should the umbilicus be dipped into?
0.5% hibitane
how often should the umbilicus be dipped if it is normal?
BID for 2-3 days post birth
how often should the umbilicus be dipped if there is a patent urachus or sepsis?
QID
what care should be provided to the mare if the foal is hospitalised?
TPR BID
check perineum
ensure milk supply
encourage mare/foal bond
check placenta has been passed
what may be tried if the mare has retained foetal membranes?
ecbolics such as oxytocin
what method of catheter placement is used in foals?
over-the-wire
why is over the wire catheter placement used in foals?
less thrombogenic
vital if septic
what position must foals be in to place a jugular IVC?
lateral recumbancy
how often should foals IVC be checked?
Q4
what about a IVC should be checked every 4 hours?
patency
vein integrity
what should be done when administering drugs through a foals IVC?
flush well to prevent sedimentation
when is extra vigilance around IVC required?
if on PN
what else is the IVC used for in foals apart from fluids and meds?
drawing blood samples
when should a blood culture be taken?
immediately from the catheter following aseptic preparation and IVC placement
what is the purpose of the IgG SNAP test?
tests for failure of passive transfer
what should the concentration of IgG be in healthy foals?
> 8.0g/L
how long does the SNAP test for IgG take to work?
10 mins
what can be done if the foal is <24 hours old and IgG is low?
supplement with colostrum via NG tube
what can be done if the foal is >24 hours old and IgG is low?
plasma transfusion
GI tract no longer absorbs ABs
what artery is used for blood gas analysis in foals?
lateral metatarsal
what is normal PaO2 for foals?
80-110 mmHg
what is normal PaCO2 for foals?
40-48 mmHg
what effect can lateral recumbancy have on PaO2?
reduced by up to 30 mmHg
what is venous blood gas used for in horses?
assessment of electrolytes
what electrolyte derangement is common in septic foals?
hypoglycaemia
why are foals at risk of hypoglycaemia?
poor glycogen and fat reserves
how can foals glucose levels be supplemented?
dextrose spiked fluidsa
what must foals on glucose spiked fluids be monitored for?
hyperglycaemia
what does lactate monitor?
tissue perfusion
what is normal lactate in neonates?
<3-4 mmol/L
what is normal lactate in foals over 3 days old?
<2 mmol/L
what does increased lactate indicate?
anaerobic metabolism
what does anaerobic metabolism lead to?
insufficient O2 supply to tissues
what is the result of insufficient O2 supply to tissues?
hypovolaemia
hypoxaemia
sepsis
what is indicated by increasing levels of lactate?
poor prognosis
what fluids will be used for fluid resuscitation in foals?
warmed Hartmanns
what fluids should not be bolused?
spiked
what is the maximum fluid volume for a 50kg foal?
max 4L
what rate should be used for fluid resuscitation of foals?
20ml/kg over 20 mins
what fluids may be used if the patient is not nursing?
hartmanns and 5% dextrose
what fluid rate is required for hartmanns and 5% dextrose?
3-5 ml/kg/hr
what rate of glucose is needed for foals?
3ml/kg/hr of 10% glucose
what are foals at risk of if on large volumes of IVFT?
subcutaneous oedema on dependent side if in lateral
why may foals develop subcutaneous oedema?
unable to tolerate high sodium concentrations in IVFT
what electrolyte may need supplementation if foals are not nursing?
K+
where are BP cuffs placed for NIBP measurement in foals?
tal
how many NIBP readings should be taken?
3 and then get an average
what BP indicates hypotension in foals?
<70 mmHg
why does sepsis cause hypotension?
suppression of myocardial contractility which reduces SV and so circulating volume
blood vessels dilate due to distributive shock which further reduces SV
how can hypotension caused by sepsis be treated?
IVFT will help but will not cure
medication also needed
why will IVFT alone not solve hypotension caused by sepsis?
heart is nor working effectively
what drugs are needed to treat hypotension induced by sepsis?
inotropes
vasopressors
what is the role of vasopressors?
constriction of blood vessels to increase SVR
what drugs increase the force of cardiac contractions?
inotropes e.g. dobutamine
what volume of urine should foals produce?
50-70% of fluid input
>2ml/kg/hr
how can foal urine concentration be described?
initially hypersthenuric then quickly become hyposthenuric
what should foals USG be?
<1.008
what should be done if foals USG is 1.008-1.012?
check kidney function
what method can be used for urine collection in foals?
free catch (labor intensive)
U cath (risk of UTI)
how is oxygen supplied to foals?
intranasal
where should tubing be inserted to for intranasal oxygen?
level of medial canthus of the eye
how can intranasal oxygen be secured in place?
taped to tongue depressor and run along face
tubing then runs through neck wrap/mane plait before connecting to oxygen
what is the oxygen supply run through before it reaches the patient?
humidifier filled with sterile water
what flow rate is usually needed for foals on oxygen?
2-15 L/min
what rate of oxygen should patients be started on?
5 L/min
how often should intranasal oxygen tubes be cleaned?
SID
how often should intranasal O2 tubes be changed?
every other day
what are the complications associated with intranasal O2?
nasal irritation
rhinitis
airway drying
what is the purpose of nebulisation with sterile saline?
secretion removal from lungs
what may be used for nebulisation?
sterile saline
bronchodilators
antibiotics
what may be performed alongside nebulisation?
manual coupage
what is the benefit of coupage?
aids mucocilliary escalator
is ventilation an option for foals?
yes but prognosis is very poor
what is the effect of prolonged seizure activity?
increases cerebral O2 demand
neurone damage
how are seizures in foals treated?
5 mg Diazepam IV
how long does diazepam last?
20 mins - can be repeated
what can be done if seizure activity continues following diazepam?
midazolam CRI
phenobarbitol
leveteracitam
what is essential when patients are seizuring?
protect from trauma
what may seizures in foals be caused by?
NMS
hypoglycaemia
sepsis
what energy requirements do sick foals have?
10% BW
why should foals not be bottle fed?
risk of aspiration
how much should foals be fed?
500ml every 2 hours for 50kg foal
what food rate should foals be started at?
50ml and build up
how can NG tube placement be checked?
x ray
how should an NG tube be secured?
same way as intranasal O2
what must be done before every feed is administered thorough an NG tube?
check for reflux
how may foals be fed?
supported to feed from mum
NG tube
bucket
TPN
what is the aim of TPN in foals?
prevention of negative energy balance rather than reaching full calorie requirement
what are the main types of enema available?
phosphate
soapy water
acetylcystine retention emema
how often can phosphate enemas be performed?
max twice in every 24 hours
what volume of soapy water can be used for an enema in foals?
~200ml
when is acetylcysteine retention enema needed?
if other 2 options have been tried
where must acetylcysteine retention enemas be performed?
in hospital
why must acetylcysteine retention enemas be performed in hospital?
usually requires sedation as foal needs to stay in lateral
what is achieved by acetylcysteine retention enema?
meconium dissolved
what is needed if foals are receiving enemas?
IVFT
