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Equine Exam 3/Final > Neonatal Express > Flashcards

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

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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

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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

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4
Q

What is the cause of premature lactation?

A
  1. Placentitis is most likely
  2. Twins
  3. Incorrect breeding dates
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5
Q

What happens during stage 1 of parturition?

A

Takes 1 to 4 hours

The fetus becomes positioned in the correct form

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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

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7
Q

What happens during stage 3 of parturition?

A

The placenta is passed

Takes less than 3 hours

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8
Q

What is the rue of 1-2-3?

A
  1. Standing in 1 hour
  2. Suckling in 2 hours
  3. Placenta is passed in 3 hours
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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

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10
Q

How should you assess the foal after birth?

A
  1. Meconium passed: 6 hours
  2. Colt urination: 6 hours
  3. Filly urination: 12 hours
  4. Suckles frequently
  5. Stands and lies down without assistance
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11
Q

What does prematurity mean?

A

A gestational time of less than 320 days and has immature physical characteristics

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12
Q

What does dysmaturity mean?

A

Inappropriate maturity for the gestational age

Likely will survive

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13
Q

What does small for gestational age mean?

A

Normal growth was interrupted

Likely will survive

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14
Q

What does unreadiness for birth mean?

A

Unable to maintain homeostasis like temp or glucose

May or may not survive

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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

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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

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17
Q

What should be evaluated from the cardiovascular system?

A
  1. Heart rate and rhythm
  2. MM membrane and color
  3. Murmur
  4. Pulse quality
  5. MAP > 60 mmHg
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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

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19
Q

What should be evaluated from the eyes of foals?

A

Entropion

Corneal ulcers

Sclera hemorrhage

Cataracts

Retinal hemorrhage

Uveitis

Persistent hyoid artery

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20
Q

What should be evaluated from the GI tract?

A

Ausculte for borborygmi

Palpate for cleft palate

Meconium

Diarrhea

Abdominal distensión

Hernias

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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

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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

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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

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24
Q

What causes a failure of passive transfer?

A

Did not get an adequate amount

Inappropriate timing

Premature lactation

Poor quality

Poor absorption

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25
Q

How do you prevent failure of passive transfer?

A

Asses colostrum quality

Make sure they ingest it in time

Check IgG levels in all foals at 18-36 hours of age

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26
Q

What can be a plan B if you are not able to get the mare colostrum into the foal?

A
  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
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27
Q

When should you test foals for passive transfer?

A

Test all foals at 18-36 hours of age
- Snap ELISA
Goal is to get IgG > 800 mg/dL
Incomplete FPT < 400 mg/dL

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28
Q

How do you treat failure of passive transfer?

A

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

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29
Q

How much milk should a healthy foal need each day?

A

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

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30
Q

What does normal nursing behavior look like in foals?

A

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

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31
Q

How do you know the foal is getting enough to eat?

A

How often do they nurse?

Are they gaining 1 to 3 lbs a day

Urine specific gravity - should be hyposthenuric

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32
Q

How can you feed orphan foals?

A

Nurse mare

Mares milk replacer

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33
Q

How do you care for the umbilicus?

A

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

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34
Q

What problems are seem with the umbilicus?

A

Infection or abscess

Hernia

Patent urachus

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35
Q

If there is an umbilical remnant infection, what structures are involved?

A
  1. Umbilical artery - most common
  2. Umbilical vein
  3. Urachus
  4. Umbilical stump
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36
Q

How do you treat umbilical remnant infections?

A

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

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37
Q

Let’s have a chat about umbilical hernias

A

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

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38
Q

Let’s have a chat about inguinal hernias

A

Can be inside (common) or outside the vaginal tunic

May require surgery

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39
Q

Let’s have a chat about patent urachus

A

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
Q

What is normal to be elevated on a neonatal biochemistry panel?

A

ALP

Bilirubin

Phosphorous

41
Q

What is abnormal to be elevated on a neonatal biochemistry panel?

A

Creatinine: consider placental insufficiency

BUN: consider protein catabolism for starvation in uñero

Lactate: watch the trend but could be perfusion problems

42
Q

What is neonatal septicemia?

A

Presence of whole bacteria or bacterial components within the bloodstream of a neonatal animal

43
Q

Through what routes can neonates become septic?

A

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
Q

What are risk factors for neonatal septicemia

A

Failure of passive transfer

Stress

Hypoxia in utero

Placentitis

Prematurity

Poor management

45
Q

What organisms can be seen with neonatal septicemia?

A

Primarily gram-negative bacteria like E. Coli, salmonella, or actinobacillus equui

Gram-positive bacteria like staph/strepto-coccus

Anaerobes - clostridium

46
Q

What are clinical signs of neonatal septicemia?

A

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
Q

How do you diagnose neonatal septicemia?

A

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
Q

How do you treat a septic foal?

A

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
Q

What does referral care look like for a septic foal?

A

Supportive care

Antibiotics

Nutrition - usually enteral

Fluid therapy to maintain electrolytes/acid base

Dextrose drip since they don’t like to eat orally

50
Q

What should always be considered with a sick neonatal foal less than 1 week old?

A

It should be considered septic until proven otherwise

51
Q

What could cause nasal regurgitation of milk?

A

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
Q

What complication should you worry about with nasal regurgitation?

A

Aspiration pneumonia

53
Q

How do you diagnose the cause of nasal regurgitation?

A

Digital exam and endoscope?

54
Q

What are your treatment considerations

A

Check the IgG and make sure the foal is getting enough nutrition

55
Q

What is cleft palate and what complications/prognosis does it have?

A

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
Q

What are differentials of colic in the foal? First do infectious

A

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
Q

What are differentials of colic in the foal? Non-infectious

A

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
Q

What are good approaches to abdominal pain in horses?

A

History and physical

Sepsis?

NG tube

Digital rectal exam

Ultrasound

Radiographs

Abdominocentesis

59
Q

What is the most common cause of colic in neonates?

A

Meconium impaction

60
Q

What is Meconium impaction?

A

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
Q

What are the signs of Meconium impaction?

A

Onset of signs is usually 12-24 hours

Decreased sucking and depression

Variable pain and abdominal distention

62
Q

How do you diagnose a Meconium impaction?

A

Digital rectal exam

Gas distended colon

Presumptive

No evidence of sepsis

63
Q

How do you treat Meconium impactions?

A
  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
Q

What are some congenital disorders of the GI tract?

A
  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
Q

What are the types of clostridium perfringens?

A

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
Q

What is clostridioides difficile?

A

Don’t worry about what they do, just that it produces both A and B toxins

67
Q

What is the diagnostic approach to dealing with foal diarrhea?

A

Consider septic until proven otherwise and offer referral

PCR panel for foal diarrhea pathogens

CBC and chem

Abdominal ultrasound

Hemorrhagic diarrhea - poor prognosis

68
Q

How do you treat a foal with diarrhea?

A

Broad spectrum antibiotics for the sepsis

Metronidazole if Clostridiosis is suspected

Fluids for electrolyte and acid-base support

Biosponge

Nutritional management

Supportive care

69
Q

What is foal heat diarrhea?

A

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
Q

What is uroperitoneum?

A

Urine within the peritoneum!

71
Q

How do you diagnose uroperitoneum?

A

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
Q

What can cause a uroperitoneum?

A
  1. Ruptured bladder
  2. Ruptured urachus
  3. Ruptured ureter
  4. Ruptured urethra

Could rupture during or after parturition

73
Q

Why is uroperitoneum a metabolic emergency and not a surgical emergency?

A

You must be worried about hyperkalemia, azotemia, and Hyponatremia. Correct those first before going to surgery!

74
Q

Are most respiratory disorder of neonatal foals primary or secondary?

A

Most are secondary to other problems

75
Q

How can you assess the respiratory system of foals?

A

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
Q

What are some basic treatment options for respiratory disorders in foals?

A

Antimicrobials therapy

Stimulate the CNS - caffeine

Oxygen/ventilator support are advanced options

77
Q

What are common neurologic diseases of foals?

A

A. Perinatal asphyxia syndrome
B. Metabolic derangements like sodium, glucose, and Ca
C. Hydrocephalus
D. Trauma
E. Meningitis

78
Q

How can you asses the neurologic disease status of foals?

A

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
Q

How do you measure seizure activity in foals?

A

Generalized, partial, or focal seizures

80
Q

What is the most common cause of neurologic disease in foals?

A

Perinatal asphyxia syndrome

81
Q

What can cause perinatal asphyxia syndrome?

A

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
Q

What are the differences between types 1 and 2 of perinatal asphyxia syndrome?

A

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
Q

What is likely to be affected with both types of perinatal asphyxia syndrome?

A

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
Q

How do you diagnose perinatal asphyxia syndrome?

A

Based on clinical signs

May be septic

May have a normal CBC and chem if uncomplicated

85
Q

How should you treat perinatal asphyxia syndrome?

A

Nutritional support

CNS support

Tissue oxygenation

Seizure control

Prevent sepsis

Good nursing care!

86
Q

What is a good control for acute seizures?

A

Diazepam

87
Q

What is a good marker for prognosis of perinatal asphyxia syndrome in foals?

A

Those that don’t do well with supportive care usually deteriorate in 48 hours

Multiple organ dysfunction and or sepsis decreases prognosis

88
Q

What is bacterial meningitis and how do you diagnose/treat it? What is the prognosis?

A

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
Q

What is metabolic neurologic dysfunction

A

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
Q

What is congenital hypothyroidism dysmaturity (CHD)?

A

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
Q

What is a common cause of increased bilirubin in foals?

A

Pre-hepatic cause - neonatal isoerythrolysis

92
Q

What is the Pathogenesis of neonatal isoerythrolysis?

A

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
Q

What other cell type can be affected with neonatal isoerythrolysis?

A

Platelets causing a thrombocytopenia but not usually at the same time

94
Q

What are clinical signs of neonatal isoerythrolysis?

A

Decreased suckle

Tachycardia and tachypnea

Weakness and lethargy

Hematuria

Icterus

1-5 days of age

95
Q

How do you diagnose neonatal isoerythrolysis?

A

Clinical signs

Cross matching

Icterus

Blood typing

Coombs testing

96
Q

How do you treat neonatal isoerythrolysis?

A

Supportive care

Transfusion from a different mare

Washing the mares RBC may be needed

97
Q

What is “donkey factor” as associated with neonatal isoerythrolysis?

A

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!

Equine Exam 3/Final (5 decks)

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