Equine Neonatal and ICU Care

Question 1

What are the three stages of a normal foaling?

Answer 1

Stage 1 (30-60mins) - cervix relaxation, uterine contractions, ends with water breaking (rupture of chorioallantois)
Stage 2 (5-30mins) - delivery of foal, if delayed assistance needed!
Stage 3 (2-3hrs) - placenta (foetal membranes) expelled, if delayed assistance needed!

Question 2

What is normal behaviour for a newborn foal?

Answer 2

Stand within 1 hour
Suckle within 2 hours
Pass meconium within 3 hours
Urinate by 8-12 hours
Sleep lying down, legs extended out

Question 3

What does a foal TPR look like immediately post-partum?

Answer 3

RR 50-80bpm
Audible crackles on lung auscultation
Mild nasal discharge

Question 4

What are normal parameters for a foal up to 7 days old?

Answer 4

HR 80-100bpm
RR 30-40bpm
Temp 37.5-39.5 degrees C
Pink moist MMs
Good peripheral pulses with warm extremities
MAP >70mmHg

Question 5

Describe the role of colostrum in foal nutrition.

Answer 5

Require about 1L in first 12hrs
Colostrum contains antibodies from mare’s blood, which are absorbed by foal’s gut in first 12-24hrs (passive transfer)

Question 6

What can go wrong when foals are born?

Answer 6

Trauma during birth e.g. rib fractures
Congenital abnormalities e.g. cleft palate, microphthalmia, limb deformities
Acquired abnormalities e.g. patent urachus
Failure of passive transfer

Question 7

What are some common conditions of neonatal foals?

Answer 7

Sepsis
Neonatal isoerythrolysis
Neonatal maladjustment syndrome
Prematurity/dysmaturity
Ruptured bladder
Diarrhoea
Pneumonia
(Meconium impaction)

Question 8

What are some clinical signs of sepsis?

Answer 8

Pyrexia
Petechiae
Injected MMs (hypotension)
Dull, flat, unresponsive
Recumbency
Uveitis, synovial sepsis, diarrhoea, pneumonia, umbilical infection

Question 9

Describe neonatal isoerythrolysis.

Answer 9

Mare produces antibodies against foal’s RBCs
Foal absorbs colostrum, RBCs broken down by antibodies
Anaemia, icterus, weakness
Foal must stop drinking from mare until no more antibodies going to be absorbed, supportive care until regenerate own RBCs, may need blood transfusion

Question 10

What is neonatal maladjustment syndrome and what are some others names for it?

Answer 10

Hypoxia in utero/during birth, causing neurological signs
AKA hypoxaemic ischaemic encephalopathy / perinatal asphyxia syndrome / dummy foal

Question 11

How can neonatal maladjustment syndrome patients present?

Answer 11

Very variable!
Poor suck reflex
Failure to nurse
Hyperaesthesia
Obtundation/coma
May be abnormal from birth or crash at 24-48hrs

Question 12

What is the difference between prematurity and dysmaturity?

Answer 12

Premature = <320 days gestation
Dysmature = normal gestation but appear premature

Question 13

What are the signs of prematurity/dysmaturity?

Answer 13

Silky coat, floppy ears, domed head
Organs and MSK system may be immature
Incomplete ossification of cuboidal bones

Question 14

Describe ruptured bladder.

Answer 14

Clinical signs at a few days old - colic, distended abdomen
Caused by trauma during birthing canal/when physically manipulated by humans
Life threatening due to electrolyte abnormalities - hyperkalaemia, increased potassium and low sodium/chloride

Question 15

Describe meconium impaction

Answer 15

Not usually an emergency
Clinical signs = straining to defecate, mild colic
IVFT, management, phosphate enema

Question 16

What general nursing care can we provide to foals?

Answer 16

Maintain sternal recumbency - prone to atelectasis
Assist to stand every 2hrs
Turn foal every 2hrs - prevent decubitus ulcers
Weigh foal daily
Careful exam

Question 17

What complete physical exam should we carry out for ICU foals?

Answer 17

Demeanour
Systems/nose-to-tail
Treatments - infusions/oxygen
Nutrition
Urine/faecal output
Full check at least every 4 hrs

Question 18

How can a foal’s eyes act as an indicator?

Answer 18

Dehydration = sunken eyes, entropion
Sepsis = injected, hypopyon (fibrin and pus accumulation), uveitis
Trauma = injected, swollen eyelids
Prone to corneal ulcers

Question 19

How should we care for the umbilicus of a foal?

Answer 19

Fill a cup with 0.5% hibitane solution to dip umbilicus into
2x daily or 4x daily if patent urachus

Question 20

How should we care for the mare post-foaling?

Answer 20

TPR twice daily
Check perineum
Ensure adequate milk, encourage mare-foal bond
Check placenta has been passed
Ecbolics? - oxytocin

Question 21

How can we place an IV catheter in a foal?

Answer 21

Over-the-wire
Less thrombogenic
Technically more difficult to place - requires 3 people
Lateral recumbency

Question 22

How do we maintain an IV catheter in a foal?

Answer 22

Check patency and vein integrity every 4hrs
Care when administering drugs - sedimentation
Extra vigilance when on parenteral nutrition

Question 23

What blood sampling can we do in foals?

Answer 23

Blood culture immediately following aseptic prep
IgG SNAP test - colostrum supplementation/plasma transfusion
Blood gas analysis
Glucose/lactate monitoring

Question 24

Describe lactate monitoring in foals?

Answer 24

Measurement of tissue perfusion
Normal <3-4mmol/L in neonates, <2mmol/L by 3 days old
Increased levels = anaerobic metabolism (hypovolaemia, hypoxaemia, sepsis)
Increased levels = worse prognosis

Question 25

Describe stabilisation of hypotension due to sepsis.

Answer 25

Sepsis causes hypotension - suppresses myocardial contractility, reduced SV, blood vessels dilate
Will not be corrected by fluid therapy alone!
Medications - inotropes e.g. dobutamine, vasopressors e.g. vasopressin

Question 26

Describe urinalysis in foals.

Answer 26

Urine output >50-70% of fluid input or >2ml/kg/hr
First urination at 8-12hrs
Initially hypersthenuric, then quickly become hyposthenuric

Question 27

What respiratory treatment can we provide to foals?

Answer 27

Intranasal oxygen, humidified
Nebulisation - sterile saline, bronchodilators, antibiotics
Ventilator - but poor prognosis by this point

Question 28

What can cause seizures in foals and what are the consequences of seizure activity?

Answer 28

May be caused by neonatal maladjustment syndrome, sepsis, hypoglycaemia, trauma, electrolyte disturbances etc.
Prolonged seizure activity increases cerebral O2 demand and can result in neurone damage

Question 29

Describe nutritional management of sick foals.

Answer 29

Require less energy - aim for 10% bodyweight
Do not bottle feed! - risk of aspiration
NG tube / total parenteral nutrition

Question 30

What are the three types of enemas that can be used in foals?

Answer 30

Phosphate enema - max. 2x in 24hrs
Soapy water - approx. 200ml
Acetylcysteine retention enema - sedated, dissolves meconium