Foal Neonatal Therapeutics Flashcards
Physical Exam & Likely Diagnosis
- T 37.9oC, HR 160, RR 40
- Mm pink but slightly tacky, CRT 2.5 sec
- No palpable rib fractures, chest auscultation WNL
- Abdomen relaxed, some meconium on perineum
- Joints and umbilicus palpate normally
- Foal is weak but able to stand with assistance, poor suck reflex and poor affinity for mare
FTPI & Sepsis
Neonatal maladjustment syndrome
Diagnostics:
- Basic haematology and biochemistry
- IgG
- Glucose and lactate
- Could consider other tests
Tx Principles:
- Maintain tissue perfusion
- Provide nutritional support
- Prevent/ treat sepsis
- Nursing care
- Treat primary disease
Lab Markers
- Blood lactate
- PCV
- Total protein
- Creatinine
- Urine specific gravity
- Blood pressure
Fluid Plan
Emergency:
- Resus
- Replace intravascular volume
Ongoing:
- Correct dehydration
- Provide fluid for maintenance
- Ongoing loss
How much volume?
** 10ml/kg bolus then reassess **
* Be more cautious if very young or severe systemic disease
Emergency Energy:
Hyperglycaemic
* Measure glucose if possible
* Glucometers not hugely accurate but will tell if high or low
* Hyperglycemia may leads to osmotic diuresis and damage to endothelium
* Energy supply rate 4 - 8mg/kg/min
* IF YOU CAN’T MEASURE & DON’T WANT HYPERGLYCAEMIA GIVE
1% = 20ml/L (Add 50% glucose to LRS) OVER 20 MINUTES
Prevent Na Overload
1 bag of plasma = meets need
<3mEq/kg/day
= 150mEq/d for 50kg foal
Ongoing Losses - Maintenance Fluid Rate
2-4ml/kg/hr
Bolus vs Continuous Infusion
Very expensive, intensive, long time
Bolus in field - cheaper, owner can do
Electrolyte Monitoring
Sodium
Potassium
Chloride
Magnesium
Foals kidneys are best at sorting themselves out
Start by giving 1L resus
Fluid Plan:
- Bolus 1L Plasmalyte over 30 mins
- Start CRI of 5% dextrose @ 4ml/kg/hr
- Defrost 1L of plasma to give
Nutrition - Normal Milk Intake:
- 5 – 7 times/ 12 minutes/ hour
- 150kcal/kg/day
- Normal foal consumes 20 - 25% of BW/day
Nutrition:
- Milk feeding should be used as much as possible = hydration, energy and stim GIT
- Sick foals require less energy
- 50 kcal/kg/day is usual target *
- Equivalent to 10% of BW/day
What to feed
Ideally mothers milk
Other horse milk
Mare milk replacer
Cow milk + 20g dextrose/L
Goats milk
How to feed
Indwelling tubes - check w scope that you’re in correctly
Tube every couple of hrs
How much to feed?
- 10% BW/ day as initial target
- For a 50kg foal
- 0.1x50 = 5L/day
- 420 mls every 2 hours
- Start conservatively and increase according to response
Dont Feed Enterally if:
- Hypothermic
- Poor perfusion
- Abdominal distension
- Lack of borborygmi
- Colic
- Reflux
Trophic Feeding
- Provide tiny volumes to foals that are not tolerating enteral nutrition well
- 25mls milk every 6 – 8 hours
- Provide some stimulus to reduce atrophy of gastrointestinal tract
Parenteral Nutrition
- Concentrated supply of intravenous carbohydrate, protein and fat
- Used in foals that are unable to tolerate enteral feeding
Treat/ Prevent Sepsis
- All sick/ recumbent/ high risk foals prone to sepsis
- Treatment/ prophylaxis usually appropriate
- Often the most important part of any treatment plan
- Ensure adequate passive transfer
- Colostrum at < 12 hours
- Plasma
- 1L per 2g IgG required
- Hygiene and clean environment
Antimicrobial Choice
- Broad spectrum bactericidal
- Bacterial infection is usually acquired from environment. Gram negative and mixed infections common
- Blood cultures should be taken from foals with suspected sepsis
Pen & Gent
Antimicrobial Considerations
- High body water content —> wider distribution of water soluble drugs
- Low body fat content —> limited redistribution of fat soluble drugs
- Immature renal and hepatic function—>alters plasma concentrations and increases risk of side effects
- Lower plasma protein concentration—>reduced protein binding capacity
- Reduced hind gut fermentation—> less tendency to develop colitis
- Ampicillin and amikacin 1st line choice (or penicillin and gentamicin)
- Ceftiofur in certain situations
Sepsis Plan
IV ampicillin and amikacin
1L plasma and recheck (likely to need 2L)
Clean hygienic environment
