Neonatal Express Flashcards
1
Q
What is the normal gestation length for a mare?
A
320-365 days
Average is 335-340
Best predictor is previous gestation length
2
Q
What conditions make a foal more high risk?
A
Maternal conditions: vaginal discharge, pre-mature lactation, surgery, or anything that makes them sick
Parturition conditions: Induction (DO NOT DO), dystocia, C-section, pre-mature or prolonged gestation, red bag (premature placental separation)
Neonatal conditions: Twins, premature, small for age, failure of passive transfer, trauma, etc
3
Q
How do you know when a mare will foal?
A
Mammary development and “waxing” drops on the end of teats
Change in mammary secretions
Tail head relaxation
Pelvic muscle and vulva relaxation
Cervix softening (don’t do a vaginal exam unless there is no other choice)
Ca spike. They won’t foal without one but may take a couple days after
4
Q
What is the cause of premature lactation?
A
- Placentitis is most likely
- Twins
- Incorrect breeding dates
5
Q
What happens during stage 1 of parturition?
A
Takes 1 to 4 hours
The fetus becomes positioned in the correct form
6
Q
What happens during stage 2 of parturition?
A
Active labor
The water will break (chorioallantois rupture)
Takes 20 to 30 minutes
If they stop progressing for 20 minutes then it becomes an emergency
7
Q
What happens during stage 3 of parturition?
A
The placenta is passed
Takes less than 3 hours
8
Q
What is the rue of 1-2-3?
A
- Standing in 1 hour
- Suckling in 2 hours
- Placenta is passed in 3 hours
9
Q
What are important things to consider postpartum for foals?
A
COLOSTRUM INGESTION is the most important
May also need enemas, umbilical care, and vit E/selenium
10
Q
How should you assess the foal after birth?
A
- Meconium passed: 6 hours
- Colt urination: 6 hours
- Filly urination: 12 hours
- Suckles frequently
- Stands and lies down without assistance
11
Q
What does prematurity mean?
A
A gestational time of less than 320 days and has immature physical characteristics
12
Q
What does dysmaturity mean?
A
Inappropriate maturity for the gestational age
Likely will survive
13
Q
What does small for gestational age mean?
A
Normal growth was interrupted
Likely will survive
14
Q
What does unreadiness for birth mean?
A
Unable to maintain homeostasis like temp or glucose
May or may not survive
15
Q
What are normal foal vital signs?
A
Temperature 100-102
Heart rate > 60 bpm at birth
Respiratory rate: starts at 60-80 breaths/min after birth but will slow to 20-40
16
Q
What are signs of immaturity and dysmaturity?
A
Low birth weight
Domed head
Short, silky hair coat
Flexible limbs
Poorly ossified cuboidal bones
Immature lungs and GI tract
Poor homeostasis
17
Q
What should be evaluated from the cardiovascular system?
A
- Heart rate and rhythm
- MM membrane and color
- Murmur
- Pulse quality
- MAP > 60 mmHg
18
Q
What should be evaluated from the respiratory tract?
A
The rate and rhythm
Palpation for rib fractures
US and radiographs
Auscultation is unreliable
19
Q
What should be evaluated from the eyes of foals?
A
Entropion
Corneal ulcers
Sclera hemorrhage
Cataracts
Retinal hemorrhage
Uveitis
Persistent hyoid artery
20
Q
What should be evaluated from the GI tract?
A
Ausculte for borborygmi
Palpate for cleft palate
Meconium
Diarrhea
Abdominal distensión
Hernias
21
Q
What should be evaluated from the umbilicus?
A
Palpate for abnormalities
Small hernias common
Dip with dilute chlorhexidine
Ultrasound
Can have a normal external umbilicus with a problem internally
22
Q
What is the importance of colostrum?
A
They do not get any antibodies before birth, so this is the single most important step
Contains mostly IgG immunoglobulin, compliment, cells, etc
Is replaced by milk in 12-24 hours
23
Q
What is failure of passive transfer?
A
A failure of the foal to get adequate transfer of antibodies. It must get high quality colostrum within 12 hours of birth. By 12 hours the GI tract is closed to most other absorption
> 800 mg/dL is usually adequate
< 200 mg/dL is very high risk and needs therapy
200-800 range are at higher risk and may need therapy
24
Q
What causes a failure of passive transfer?
A
Did not get an adequate amount
Inappropriate timing
Premature lactation
Poor quality
Poor absorption
25
How do you prevent failure of passive transfer?
Asses colostrum quality
Make sure they ingest it in time
Check IgG levels in all foals at 18-36 hours of age
26
What can be a plan B if you are not able to get the mare colostrum into the foal?
1. Colostrum from the dam
2. Banked colostrum
3. Bovine colostrum (okay; better than nothing)
4. Equine IgG products are not as good and they need lots
27
When should you test foals for passive transfer?
Test all foals at 18-36 hours of age
- Snap ELISA
Goal is to get IgG > 800 mg/dL
Incomplete FPT < 400 mg/dL
28
How do you treat failure of passive transfer?
Use commercial equine plasma!
Start slow to monitor for plasma adverse reactions
Can give 1 liter over 20-30 minutes in a healthy foal
At least 2 liters required for most complete FPT
Recheck IgG after 12 -24 hours
29
How much milk should a healthy foal need each day?
Example - 50 kg foal
Healthy foals should receive a volume of mares milk = 20-25% of their body weight each day
50kg x 0.2 = 10L/day
10L/24 hours = 417 mL/hr
Can be done with 25% as well
Start with smaller 50-100mL quantities to see if it would be tolerated by the foal
30
What does normal nursing behavior look like in foals?
They go from nursing up to 6 times an hour in the first week to less than 1 time an hour in the first 4 weeks
31
How do you know the foal is getting enough to eat?
How often do they nurse?
Are they gaining 1 to 3 lbs a day
Urine specific gravity - should be hyposthenuric
32
How can you feed orphan foals?
Nurse mare
Mares milk replacer
33
How do you care for the umbilicus?
Allow it to break naturally
Disinfect 2 or more times daily until its dry
Use 0.5% chlorohexidine, 2% iodine, or 1% povidone iodine
- Do not use 7% tincture of iodine
34
What problems are seem with the umbilicus?
Infection or abscess
Hernia
Patent urachus
35
If there is an umbilical remnant infection, what structures are involved?
1. Umbilical artery - most common
2. Umbilical vein
3. Urachus
4. Umbilical stump
36
How do you treat umbilical remnant infections?
Evaluate with ultrasound as external may be normal
Medical or surgical tax depends on how sick they are and what other issues are going on
Use antibiotics for gram neg usually
Monitor joints - they are common spots for bacteremia to go
37
Let’s have a chat about umbilical hernias
Small hernias are very common and often will resolve on their own!
Bowel MAY become entrapped so use an ultrasound
Use clamps or elastic rings if needed to fix
38
Let’s have a chat about inguinal hernias
Can be inside (common) or outside the vaginal tunic
May require surgery
39
Let’s have a chat about patent urachus
Will see urine coming from the penis or at least notice a constant wet area under the foal
Not uncommon and may appear after a day or two post parturition
Treatment usually medical but may require surgery
Antimicrobials may be indicated
40
What is normal to be elevated on a neonatal biochemistry panel?
ALP
Bilirubin
Phosphorous
41
What is abnormal to be elevated on a neonatal biochemistry panel?
Creatinine: consider placental insufficiency
BUN: consider protein catabolism for starvation in uñero
Lactate: watch the trend but could be perfusion problems
42
What is neonatal septicemia?
Presence of whole bacteria or bacterial components within the bloodstream of a neonatal animal
43
Through what routes can neonates become septic?
In utero - and they’ll sing “I’m on the right [wrong] track, baby, I was born this way” - Lady Gaga
Ingestion
Inhalation
Umbilicus
44
What are risk factors for neonatal septicemia
Failure of passive transfer
Stress
Hypoxia in utero
Placentitis
Prematurity
Poor management
45
What organisms can be seen with neonatal septicemia?
Primarily gram-negative bacteria like E. Coli, salmonella, or actinobacillus equui
Gram-positive bacteria like staph/strepto-coccus
Anaerobes - clostridium
46
What are clinical signs of neonatal septicemia?
Onset is generally less than 7 days old but could be variable
**Decreased suckle reflex and lethargy**
If not drinking the mares udder will be full, high USG, and it will be hypoglycemic
+/- pyrexia
Dehydration
Toxic MM
Poor peripheral perfusion with cold limbs and poor pulse
Other signs of localized infection; lungs, GI, nervous, joints
47
How do you diagnose neonatal septicemia?
Presumptive based on history (FPT), clinical signs, age, left shift neutrophilia with toxic changes. Increased lactate, hypoglycemia, etc
Confirmative with blood culture (may not be positive), necropsy culture, histo, or culture of the localized infection site
48
How do you treat a septic foal?
Refer! Only emergency stabilization at the farm
Stabilization treatment could include
A. Resuscitation
B. Monitor for hypothermia
C. Check blood glucose and supplement if needed
D. Control seizure
E. Possible fluid bolus to increase perfusion - but be careful to not overload
49
What does referral care look like for a septic foal?
Supportive care
Antibiotics
Nutrition - usually enteral
Fluid therapy to maintain electrolytes/acid base
Dextrose drip since they don’t like to eat orally
50
What should always be considered with a sick neonatal foal less than 1 week old?
It should be considered septic until proven otherwise
51
What could cause nasal regurgitation of milk?
Generalized weakness - most common
- Sepsis or prematurity
- Neurologic disease
- HYPP - homozygous (don’t have good pharyngeal function)
- Selenium deficiency
Pharyngeal abnormalities
- Cleft palate
- Subepiglottic cysts
- Dorsal displacement of the soft palate
Esophageal abnormalities
52
What complication should you worry about with nasal regurgitation?
Aspiration pneumonia
53
How do you diagnose the cause of nasal regurgitation?
Digital exam and endoscope?
54
What are your treatment considerations
Check the IgG and make sure the foal is getting enough nutrition
55
What is cleft palate and what complications/prognosis does it have?
Clefts in the soft palate are more common where the epiglottis will sit on top of the soft palate
Aspiration pneumonia is common
Surgery or euthanasia are best options
56
What are differentials of colic in the foal? First do infectious
Neonates
A. Septicemia
B. Salmonellosis
C. Clostridiosis
Older foals
1. Rotavirus - usually a week or more
2. Cryptosporidium - 10 to 14 days
3. Salmonellosis, Clostridiosis
57
What are differentials of colic in the foal? Non-infectious
Neonates
1. Meconium impaction until proven otherwise
2. Perinatal asphyxia
3. Congenital disorders
Non-infectious
A. Gastroduodenal ulcer syndrome
B. Sand
C. Foreign bodies like mommas hair
EVERYTHING that happens in adults
58
What are good approaches to abdominal pain in horses?
History and physical
Sepsis?
NG tube
Digital rectal exam
Ultrasound
Radiographs
Abdominocentesis
59
What is the most common cause of colic in neonates?
Meconium impaction
60
What is Meconium impaction?
Meconium is the first feces passed by the foal and has bile, mucus, and epithelial cells. It is dark brown to black in color.
It can cause colic in neonates
61
What are the signs of Meconium impaction?
Onset of signs is usually 12-24 hours
Decreased sucking and depression
Variable pain and abdominal distention
62
How do you diagnose a Meconium impaction?
Digital rectal exam
Gas distended colon
Presumptive
No evidence of sepsis
63
How do you treat Meconium impactions?
1. Enemas (no phosphate based fleet enemas)
2. Acetylcysteine retention enemas
- Acetylcysteine breaks up disulfide bonds in mucus. Given with Foley catheter
3. Repeated enemas may be needed
4. Oral laxatives or fluids
5. IV fluids
6. Pain control
7. Surgery may be required in rare cases
64
What are some congenital disorders of the GI tract?
1. Atresia Coli - rare
2. Atresia ani - rare
3. Lethal white syndrome
- rare mutation that causes a lack of submucosal and myenteric ganglia
- foal is all white and parents are frame overo patter
65
What are the types of clostridium perfringens?
Can infect neonates
Type A: Present in normal foal feces by 6 days. It produces alpha toxin and netF toxin, which may be associated with necrotizing enterocolitis
Type C: Is uncommon in healthy foals but produces beta toxin. This can cause inflammation, necrosis, or increased capillary permeability.
- Beta toxin is trypsin sensitive and will be destroyed by it. Antiprotease activity in colostrum/milk can prevent the inactivation of the toxin.
66
What is clostridioides difficile?
Don’t worry about what they do, just that it produces both A and B toxins
67
What is the diagnostic approach to dealing with foal diarrhea?
Consider septic until proven otherwise and offer referral
PCR panel for foal diarrhea pathogens
CBC and chem
Abdominal ultrasound
Hemorrhagic diarrhea - poor prognosis
68
How do you treat a foal with diarrhea?
Broad spectrum antibiotics for the sepsis
Metronidazole if Clostridiosis is suspected
Fluids for electrolyte and acid-base support
Biosponge
Nutritional management
Supportive care
69
What is foal heat diarrhea?
Most common cause of diarrhea in foals - Normal
- Occurs 7-12 days post partum, but can correspond to the ending of the mares post foaling estrus
- Hypersecretion into the small intestine overwhelms the absorptive capacity of the immature colon
- Nothing is wrong! Let them get over it
70
What is uroperitoneum?
Urine within the peritoneum!
71
How do you diagnose uroperitoneum?
Ultrasound:
- Will find free peritoneal fluid
- Defect in the bladder or urachus
- Collapsed bladder
Peritoneal fluid:serum creatinine ratio (abdominocentesis)
- Ratio of >2 is diagnostic
Electrolyte abnormalities
- Hyponatremia
- Hypochloremia
- Hyperkalemia
72
What can cause a uroperitoneum?
1. Ruptured bladder
2. Ruptured urachus
3. Ruptured ureter
4. Ruptured urethra
Could rupture during or after parturition
73
Why is uroperitoneum a metabolic emergency and not a surgical emergency?
You must be worried about hyperkalemia, azotemia, and Hyponatremia. Correct those first before going to surgery!
74
Are most respiratory disorder of neonatal foals primary or secondary?
Most are secondary to other problems
75
How can you assess the respiratory system of foals?
Rate and pattern of breathing between the abdomen and rib cage; should be moving together
Ultrasound
Thoracic radiography
Arterial blood gas
Auscultation or MM color is not reliable
76
What are some basic treatment options for respiratory disorders in foals?
Antimicrobials therapy
Stimulate the CNS - caffeine
Oxygen/ventilator support are advanced options
77
What are common neurologic diseases of foals?
A. Perinatal asphyxia syndrome
B. Metabolic derangements like sodium, glucose, and Ca
C. Hydrocephalus
D. Trauma
E. Meningitis
78
How can you asses the neurologic disease status of foals?
How long does it take to stand? About 2 hours
Follows the mare closely
May become limp and collapse with restraint
Delayed menace response (2 weeks of age)
May be hypersensitive to stimuli around head/neck
Crossed extensor reflex
79
How do you measure seizure activity in foals?
Generalized, partial, or focal seizures
80
What is the most common cause of neurologic disease in foals?
Perinatal asphyxia syndrome
81
What can cause perinatal asphyxia syndrome?
Many causes but most boil down to a lack of oxygen availability (or blood flow) during pre-partum, parturition, or just problems with the foal.
Can have issues at birth or overtime
Ones that are born normal likely didn’t have in utero problems
82
What are the differences between types 1 and 2 of perinatal asphyxia syndrome?
Type 1
- Born normal and signs develop within 48 hours
- Up to 75-80% survival
Type 2
- Born abnormal
- Up to 50-75% survival
83
What is likely to be affected with both types of perinatal asphyxia syndrome?
CNS dysfunction is prominent and usually cerebral
Other organs like kidney, liver, GI tract, bladder, or lungs, may be affected
Severity of clinical signs depends on the type, severity, and duration of insult
- Almost all will still stop commonly stop suckling and stop being attentive to mommy
84
How do you diagnose perinatal asphyxia syndrome?
Based on clinical signs
May be septic
May have a normal CBC and chem if uncomplicated
85
How should you treat perinatal asphyxia syndrome?
Nutritional support
CNS support
Tissue oxygenation
Seizure control
Prevent sepsis
Good nursing care!
86
What is a good control for acute seizures?
Diazepam
87
What is a good marker for prognosis of perinatal asphyxia syndrome in foals?
Those that don’t do well with supportive care usually deteriorate in 48 hours
Multiple organ dysfunction and or sepsis decreases prognosis
88
What is bacterial meningitis and how do you diagnose/treat it? What is the prognosis?
Bacteria causing inflammation of the meninges leading to forebrain signs
Usually rapid to progressive seizures
Diagnosis with CSF analysis
Broad spectrum ABX
Guarded to poor prognosis
89
What is metabolic neurologic dysfunction
An imbalance of:
1.Sodium (both high, leading to cerebral edema, and low, leading to cerebral dehydration)
2. Low calcium and magnesium causing tetany and rigidity
3. Low glucose leading to seizures or obtundedness
4. Metabolic acidosis
90
What is congenital hypothyroidism dysmaturity (CHD)?
Prolonged gestation that also has:
- Mandibular prognathism
- Contracted tendons
- Delayed ossification of cuboidal bones
- Hernias
Risk factors could be mustard plants, nitrates, or lack of mineral supplements
Thx is supportive
Prognosis is guarded
91
What is a common cause of increased bilirubin in foals?
Pre-hepatic cause - neonatal isoerythrolysis
92
What is the Pathogenesis of neonatal isoerythrolysis?
First pregnancy:
1. The foal inherits a foreign antigen from the sire (Aa, Qa)
2. The mare becomes to sensitized to the RBC antigen
3. Mare produces antibodies to that antigen
Second pregnancy:
1. Antibodies are concentrated in the colostrum which the foal ingests
2. Antibodies against the foal RBC cause hemolysis or agglutination
93
What other cell type can be affected with neonatal isoerythrolysis?
Platelets causing a thrombocytopenia but not usually at the same time
94
What are clinical signs of neonatal isoerythrolysis?
Decreased suckle
Tachycardia and tachypnea
Weakness and lethargy
Hematuria
Icterus
1-5 days of age
95
How do you diagnose neonatal isoerythrolysis?
Clinical signs
Cross matching
Icterus
Blood typing
Coombs testing
96
How do you treat neonatal isoerythrolysis?
Supportive care
Transfusion from a different mare
Washing the mares RBC may be needed
97
What is “donkey factor” as associated with neonatal isoerythrolysis?
All donkeys and mules have the antigen that sparks the mare to react and produce antibodies against it. The incidence for NI in donkeys/mules is therefore higher!
