Neonate Flashcards
Stood within 3 hours– administered banked colostrum
* appeared to nurse well
* IgG concentration checked at 18 hours- 600 mg/dL
* Foal now lying down more often and no longer appears to be nursing aggressively
Physical examination: foal:
- weak and depressed
- Weak suckle
- Injected MM
- HR 96/min
- 56/min
- Temp 37.3C
- Cool extremities
Problem list– what does leukopaenia mean??
Blood culture results– generally??
Most common blood culture isolates in foals
Differences in blood culture results?
SIRS and Sepsis in foals
Compensatory anti-inflamm response in SIRS and sepsis? Mixed anti-inflamm response?
Inflammation and coagulation in sepsis
Equine Neonatal Sepsis
Neonatal Sepsis
Neonatal Sepsis:
Treatment
Neonatal Sepsis:
Treatment Hemodynamic Support
Neonatal Sepsis:
Treatment
Respiratory Support
Neonatal Sepsis:
Treatment
Nutritional Support:
Neonatal Sepsis:
Treatment
Plasma Transfusion
Neonatal Sepsis:
Treatment
Nursing and Supportive Care
Neonatal Sepsis:
Complications
Neonatal Sepsis:
Prognosis
The high risk mare historical events
High risk mare events during current pregnancy
the high risk mare events during parturition
Management of calving prior to
Calving environment:
- protection from adverse weather
- limit environmental contamination with potential pathogens
* Close observation during calving:
- allows timely intervention if a problem should occur
- hours (rather than minutes for foals)
* Calf weight
Evaluation of the neonate
Physical exam of neonate cardiovascular system
* Persistent bradycardia: hypothermia/ hypoglycaemia/hypoxaemia
* Persistent tachycardia:
- sepsis, hypovolaemia
- pain, fever, excitement
- congenital defects (esp if accompanied by load murmurs)
Physical exam of neonates respiratory system
Physical exam of neonate– abdomen
Physical exam of the neonate musculoskeletal system
* flexor laxity: SBs, foals often struggle to rise, difficulty standing to nurse, distal limb edema, trauma to palmar/ plantar aspect
* Resolve as foal gains strength and becomes more active: heel extensions, avoid bandaging
* Flexor contraction:
- foals often struggle to rise
- difficulty standing to nurse
- trauma dorsal aspect of limb
- extensor rupture
* Resolve as becomes more active: physiotherapy, bandaging/splints, toe extensions/ heel elevation/ oxytet (kidneys!!)
Laboratory Evaluation neonates (general)
Lab eval changes to leukogram in neonates
Neonate changes to lab– haemogram
Plasma biochemistry in neonates
* Serum IgG concentration
- maximum plasma concentration at approx 18 hours
- t1/2 in healthy foals approx. 12 to 25 days
- Partial failure of passive transfer: 400-800 mg/dL
- Complete failure of passive transfer
* Serial evaluation
- consumption (antigen-antibody complexes)
- catabolism (negative energy balance)
Common causes of the sick neonate
Neonatal disease treatment
Neonatal disease: treatment common agents
Neonatal disease treatment– haemodynamic support
Neonatal disease treatment: nutritional support
Anti-inflammatories and analgesia in foals
Plasma transfusion in foals
Fluid plans
Why are we administering fluids to this patient?
Crystalloids
Why dont you administer bicarbonate to foals?
Why harmann’s? Why low K?
Volume to be administered
Identifying fluid requirements– percent dehydration
Clinical signs that help ID fluid requirements
How can clinical pathology help ID fluid requirements?
Poor correlation between actual fluid requirements and fluid requirements from clinical sign in horses… otherwise how do you calculate the fluid deficit??
Volume to be administered in each phase?
For horses requiring rapid fluid resuscitation, concentrate on rapidly correcting hypovolaemia by how much volume??
After how many boluses, what do you?
Goals of acute fluid resuscitation?
Maintenance?
At the end of the day, fluid rate depends on what?
Using the resuscitation approach– administer 20 mL/kg over 30-60 minutes
Monitoring fluid therapy
* Careful physical examination
- measurements should be performed at frequent intervals as trends are generally more informative
- Clinicopathology markers: PCV; TS; urine output and specific gravity, and LCA….. Na, K, Ca, Mg
- Additional monitoring techniques: blood pressure monitors, central venous pressure
Renal function
Renal function review
Physical Examination
Dull demeanour
Clinically mildly dehydrated
Mild abdominal distension
HR 80 /min
RR 16 /min
T 37.9
o
C
Mucous membranes pink with a normal CRT
DDX?
next step?
confirming uroabdomen?
Uroabdomen
Sick recumbent foals may have bladder distension due to inadequate emptying. Risk rupture when moving/flipping foal. Healthy foals may rupture during birth due to full bladder and pressure during parturition. Urachus (associated with infection) or rarely ureter may also rupture.
Clinical signs of uroabdomen
Electrolyte abnormalities may not occur or be obvious in sick foals already on fluids. Foal diet is milk: potassium rich, sodium poor. Inability to excrete potassium and excess water leads to electrolyte abnormalities.
Diagnosis uroabdomen
Electrolyte abnormalities may not occur or be obvious in sick foals already on fluids. Foal diet is milk: potassium rich, sodium poor. Inability to excrete potassium and excess water leads to electrolyte abnormalities.
in uroabdomen
stabilization uroabdomen
Stabilization Peritoneal drainage
Stabilization
Hyperkalaemia
Hyperkalaemia
:
Other things to consider:
Calcium
borogluconate
(23% solution)
Helps restore normal differential between resting
membrane potential and firing threshold
IV
fluids
with low [K
+
] often recommended
Probably unnecessary in most cases
Stabilization
Hypovolaemia
What’s
your next step?
History:
Foal
Foal stood after 55 min
Nursed about 35 min after standing
Physical examination at 18 h normal
[IgG] 1400 mg/
dL
The farm manager reports that the foal
appeared completely normal for the first
24 hours of life but now appears lethargic
and is not interested in nursing
Physical Examination
Clinically, mildly dehydrated
Sclera and mucous membranes
slightly
injected
HR 120 /min
Machinery
-
type murmur on auscultation
RR 36 /min
Pulmonary auscultation considered normal
T 38.3
o
C
Palpation of the limbs, umbilicus and abdomen considered
normal
inc
Hematocrit (%)Glucose Aspartate Aminotransferase (AST)
Creatine
Kinase
Glutamyl
Transferase
(GGT)
** Next steps: I’m going to collect samples for CBC, biochem and culture
What does uterine stress cause?
Increase in Creatinine concentration, unsure exactly why but it does increase in uterine fluids
** Neonatal Encephalopathy
Neonatal Encephalopathy
NE also seen with
in utero
exposure to?
Neonatal Encephalopathy
Clinical Signs
Are there any risk factors that would make this foal susceptible to NE?
Can we definitely exclude sepsis?
Mild dystocia and thickened placenta
** No we cannot definitely exclude sepsis
O
rgans other than the brain? ddx?
Neonatal Encephalopathy
Treatment
Treatment: Early identification!! Affected foals are commonly septic or become septic– broad spectrum antimicrobials
Supportive care
Monitor GI and renal function
Ensure adequate DO
2
:
Adequate oxygenation (INO
2
)
Maintain blood pressure
Careful
glucose
management
Excellent nursing care and careful,
repeated monitoring
Treatment:
Anti
-
inflammatories/analgesics
Flunixin
meglumine
Corticosteroids
NOT
indicated
Treatments
to reduce cerebral
oedema
, support brain function
and scavenge free radicals
…??
Neonatal Encephalopathy
Hemodynamic Support
Neonatal Encephalopathy
Respiratory Support
Neonatal Encephalopathy
Nutritional Support
Neonatal Encephalopathy
Nutritional Support:
Start with very small meals
initially
Normal foal:
20% BW/day
approx
850 mL q 2h
NE foal:
50
-
100 mL q 2h (
approx
2% BW/day) initially
Gradually increase if enteral nutrition is tolerated
Consider early institution of TPN in foals that do not
tolerate enteral feeding
Monitor [Glucose], [Triglycerides] and [Electrolytes]
Nutrition for enterocytes?
Neonatal Encephalopathy
Neuroprotective
Strategies
Neonatal
Encephalopathy
Nursing Care
How are you going to treat this foal? ne
hx and S v. M in foal colic
Mild signs
Foal colic
Severe signs
Foal colic
Foal colic: 6
-24 hours
•
Meconium:
•
Glandular secretions
from GI tract, amniotic
fluid and cellular debris
•
Should be passed by
24-
36 hours of age
•
In utero sepsis
: associated
hypoglycaemia
and
sympathamomimetic
release: can induced
hypomotility
•
High risk for meconium impactions
•
More common in colts (narrow pelvic canal)
foal colic diagnosis
foal colic tx
•
Fluids or laxatives
•
Analgesia
•
1.1mg/kg
flunixin
IV SID
•
Butorphanol
1-2mg IV /IM q4
-12 hours
Lethal White Foal Syndrome
Common myths
about lethal
white foals
Foal colic: 2
-5 days
Foal colic: 2
-5 days diagnosis
Foal colic clin signs
Foal colic: SI obstruction
Foal colic: SI obstruction diagnosis
Ascarid impaction diagnosis
Ascarid impaction tx
foal colic tx
Intussusception
Herniation
Herniation tx
indications for Hernia sx
Gastroduodenal ulceration
Gastroduodenal ulceration clin signs
Gastroduodenal ulceration in neonates
Gastroduodenal ulceration
•
2-5 month old foals with reflux and low gr colic
•
Previous history of illness /
hospitalisation
•
Suspected gastric outflow obstruction
•
(pyloric +/
- duodenal ulceration /stricture)
•
Evaluate emptying of stomach
•
Contrast radiography
•
Delay= barium in stomach after 2hrs
•
Could be inflammatory /stricture
•
Fecal or gastric occult blood
•
insensitive, nonspecific
Gastroduodenal ulceration med mgt
summary foal colic
Questions for farm manager about unwell foal
