Normal foaling, normal foals and pre- & dysmature foals

Question 1

What should be done before an expected foaling? (4)

Answer 1

Mare should live at the stable/in the foaling stall she is going to give birth in for 4-6 (weeks?) before the expected foaling.
* This give time to produce antibodies to local pathogens.
* Straw bedding should be used (avoid shavings)
* Foaling box should be big enough.

Vaccinations up to date.
* Boosters 4-6 weeks before foaling
* Tetanus too!

If mare has Caslick suture, remove 1-2 weeks before.
* In local anesthesia

Consider Deworming the mare about 2 weeks before foaling, against Strongyloides westeri with ivermectin.
* To reduce the shedding of Strongyloides westeri larvae in the environment and through the mare’s milk.

A Caslick’s suture is used in mares to treat vulvar trauma, pneumovagina, vaginitis and infertility. Poor vulvar conformation can usually be addressed with a Caslick’s procedure. The edges of the vulval lips are sutured closed to prevent aspiration of air and faeces.

Question 2

Mammary development in the mare before foaling. (5)

Answer 2

• Begins 4-6 weeks before, most marked in last 2 weeks.
• Teats fill up 4-6 days before foaling.
• Waxy drops of dried colostrum appear on the teats 1-4 days before foaling.
• Electrolytes change in milk if foaling is imminent - K & Ca ↑, Na ↓
• Not very reliable indicator though since maiden mares often do not have these signs.

Too early udder development and milk running from the udder are signs of the problems!

Question 3

When foaling is approaching, what should you do? (3)

Answer 3

Foaling should be observed.
* Most mares foal at night
* Utilize Cameras, foaling alarms etc.
* Do not disturb the mare unless needed though.

• Mare may separate from the herd, be anxious, bit off food when foaling is near (24h).
• Mare may be colicky at the 1st stage of labor which is Difficult to distinguish from real colic.
• Foaling should be progressive though! not standstill.

Question 4

Describe the stages of Normal foaling. (3)

Answer 4

1st stage: 30 min- 4 h
* Mare may show mild colic signs
* Repositioning of the foal occurs
* Ends with the rupture of chorioallantois

2nd stage: 20-30 min
* If no progression in 10 min, vaginal examination.
* Use Cleaning! Lubricant!

3rd stage: up to 3 hours
* Placenta out

Question 5

Criteria for a normal foal: (4)

Answer 5

• Healthy mare
• Normal gestational lentgh, that being 320-360 days (315-365 days). Average 341 days.
• Uncomplicated delivery
• Foal’s physiological parametres inside reference values.

Question 6

What to expect from the neonatal foal after birth. (5)

Answer 6

• Should be sternal in 5 min after birth.
• Suckling reflex 2-20 min after birth.

“1-2-3 rule”
* Up in 1h (Most try to get up 10-20 min after birth.)
* Suckling in 2h (most suckle sooner)
* Placenta out in 3h. If too fast (less than 15 min), also a risk: look for signs of O2 deprivation in the foal.

Every deviation from a normal timeline is a cause for a concern!

Question 7

“1-2-3 rule” for foals

Answer 7

• Up in 1h
• Suckling in 2h
• Placenta out in 3h

Question 8

Decribe the cardiovascular system of a newborn foal.

Answer 8

HR changes during the first 24h.
* Less than 1h old: ca 60/min
* 2-12 h: 100-200/min
* After 24 h : 80-100/ min
* Slowly decreases in older foals

• Cardiac arrhythmias are normal in the first hour.
• Systolic murmurs normal during first 3 days.
• MM pink, moist and crt <2 sec

Question 9

Describe the Respiratory system of a newborn foal.

Answer 9

• Respiratory rate in first hour: 60-80/min
• After 24h: 20-40/min
• Assessment of breathing effort more useful than breathing sounds.
• Soft crackles during first hours are normal.

Palpate ribs for fractures (dystocia related).
* U/S is more sensitive though.
* Usually unilateral fractures.
* If fractured rib(s) detected, affected side to the ground.

Question 10

Describe the Temperature of a newborn foal.

Answer 10

Normal temperature is 37,8- 39°C.
* Should be achieved by 1 hour after birth.
* Normal foal can maintain this temperature even in cold environment!

NB Hypothermia is common in sick foals.

Foal must be kept in dry and warm environment.
* Hypothermia can develop very fast and foal can deteriorate quickly!
* Hypothermic foals do not get up and suckle which compromises the foals even further.
* They Don’t have energy reserves and adequate response to cold, they need energy from milk to
maintain normothermia.

Question 11

Describe Vision in the newborn foal. (6)

Answer 11

• No menace reflex until 2-3 weeks old
• PLR slower
• Check for entropion
• Cornea is less sensitive (so,)
• Check for ulcers
• Especially recumbent foals

Question 12

Describe the Neurological status/behavior of a newborn foal. (6)

Answer 12

• Finds the udder and suckles several times per hour.
• Normal foal: gets up → suckles → urinates → plays → goes to sleep.
• Movements are sharp, gait a bit hypermetric.
• Tries to escape from humans.
• Stimulation results in exaggerated head movements.
• Can sleep very deeply.

Question 13

Describe the timeline for Colostrum absorption in foals.

Answer 13

If the mare’s milk has been leaking for days before foaling, the colostrum is lost.

The Foal’s Ability to absorb antibodies decreases within hours! Best absorption when in 3-6 h old.

Almost non-existent absorption in a 20 h old foal!

Question 14

Describe Meconium after foaling.

Answer 14

Meconium is Dark brown firm/pasty fecal mass
composed of cellular debris, intestinal secretions,
bilirubin and amniotic fluid ingested by the foal.

• Should start passing within 3-6 hours of birth.
• All of it should be passed during first 24 h of life.

Normal feces after meconium are soft and light
colored (yellowish/orange) and should pass with no straining.

Question 15

Describe Urination in the newborn foal.

Answer 15

First urination typically at 6-12 h of age
* Colts: 5-6 h
* Fillies: 10-11 h

First urine SG >1,020; then decreases to hypostenuric.

• Normal foal urine is quite dilute SG <1,010 (1,001-1,010 g/l)
• It is normal for male foals not to drop penis while urinating.
• Do not forcefully try to exteriorize the penis!
• Persistent frenulum spontaneously breaks within a few days.
• Over 24 hrs of age – urine production ca. 150ml/kg/day which is 5-10 times more than an adult horse (but they’re on an all milk diet so).

Question 16

Describe the umbilicus in the newborn foal and how to care for it.

Answer 16

The Umbilical cord usually ruptures 3-5 cm from the body wall When the mare or foal tries to stand.

• Use Chlorhexidine 0,5% spray or dip for umbilical disinfection. These are Preferred to iodine these days. (NOT concentrated iodine! (predisposes to patent urachus))
• Disinfect it Every 6 hours in first 24h.
• Umbilicus should be dry, no urine from the umbilicus.
• Small and painless on palpation.
• If the umbilicus is bleeding: ligate with umbilical tape.
• Check for umbilical hernia

NB! Always use gloves

Question 17

Assessment of neonatal foal. Maternal risk factors for getting a sick foal: (8)

Answer 17

• previous or concurrent disease
• prolonged transport during pregnancy
• malnutrition
• poor perineal conformation
• placentitis
• premature lactation
• twins
• history of delivering a sick foal

Question 18

Assessment of neonatal foal. Foal risk factors for getting a sick foal: (4)

Answer 18

• Premature (<320 days)
• Born during adverse environmental conditions
• Result of dystocia/red bag delivery
• Do not achieve certain „milestones“

Should be examined immediately if any risk factor present or not progressing timely. Without any problems, foals should still be examined by 12-24h of age. Ideally IgG should also be measured from all.

In a ‘red bag’ delivery the placenta has partially or completely separated from the mares endometrium (lining of the uterus) prior to the foal being delivered. This means that the foal is getting no oxygen from the time of separation (or reduced oxygen in the case of partial separation) to the time it is delivered.

Question 19

Visiting a compromised foal: If immediate emergency treatment is required what do you start with?

Answer 19

Assess Mm, heart rate and rhythm, resp rate and pattern.

Full anamnesis and examination can wait if foal needs:
* Fluid therapy
* Oxygen
* CPR

Very few conditions that worsen if given 2 L of fluids so you could do this pretty quickly.

Question 20

Clinical examination of a foal.

Answer 20

NB! Always wear gloves when you handle the foal

At a distance:
* Mentation, nursing, urination
* Limbs: angular/flexular deformities
* RR
* Signs of dysmaturity
(Low birth weight; thin body condition. Short, silky hair coat. Floppy ears, soft muzzle, flexor tendon laxity, periarticular laxity.)

Physical examination:
* Temp, hr, mm
* Breathing sounds and effort, check for rib fractures
* Palpate the joints
* Urination
* Umbilicus
* Examination of the eyes: cataracts, corneal ulcers, entropion…
* Also check the mare and placenta.

Question 21

How do you fixate a foal?

Answer 21

grab base of tail with one hand and hold under chin/around neck with the other arm.

Question 22

How do you make sure that the foal has enough antibodies?

Answer 22

• IgG – SNAP test at 12-24h of age
• Measured from EDTA-blood sample
• Definitely check, if problems with foal or risk factors present.
• Ideally check every foal-

Results:
* <400g/dl = total FPT
* 400-800g/dl = partial FPT
* >800g/dl = adequate level

Measurement of plain blood globulins is not an adequate means to evaluate antibody levels, do the Ig snaptest or quantitative test.

failure of passive transfer = FPT

Question 23

Laboratory assessment: hematology from foals.

Answer 23

Hematology should be taken from every foal that is considered abnormal.

• Leukocytes: references same with adults
• Hb and PCV are higher after birth→ decrease during first 2 weeks → remain at lower end of adult reference values.
• Fibrinogen; if Elevation at birth = infection already present in uterus.
• If very low in sick foal: severe coagulopathy

Question 24

Laboratory assessment: SAA in foals.

Answer 24

• Very sensitive marker of inflammation and
  infection
• Even small inflammatory stimulus can
  cause marked changes
• Changes fast compared to fibrinogen
• Values comparable to adults
• NB! there is SAA in colostrum
• Handheld readers
• Rather expensive and usually need to repeat to evaluate the progression.

Question 25

Laboratory assessment: biochemistry in foals.

Answer 25

* TP, alb * CK, bilirubin, GGT, AST Creatinine * High creatinine at birth is often sign of placental pathology and/or fetal stress rather than renal disease → should decrease rapidly (50% in first 24h). * But renal origin also common. Lactate * Elevation means decreased organ perfusion. * Normal after being born 0,4- 4,4 mmol/l → should steadily decrease. * Measure Electrolytes (Na, K, Cl) while youre at it.

Question 26

Laboratory assessment: blood glucose in foals.

Answer 26

Reference range (80-130 mg/dL) * 4.4-7,2 mmol/l Foals with blood glucose concentrations <2.8 mmol/L (50 mg/dL) or >10 mmol/L (180 mg/dL) at admission = are less likely to survive. Hypoglycemia at admission is associated with * sepsis * positive blood culture * SIRS

Question 27

Diagnostic imaging in the neonatal foal.

Answer 27

Ultrasound for: * Rib fractures * Umbilical structures * Abdomen: intestines, free fluid * Lungs Radiographs: * At least for Premature/dysmature foals * Sometimes lungs/abdominal cavity in mature foals as well.

Question 28

Common reasons for morbidity and mortality of the foals during neonatal period: (3)

Answer 28

* Pre/dysmaturity * PAS (perinatal asphyxia syndrome) (dummy foals) * Sepsis Almost always need referral to the clinic. Refer when foal needs one of the following: * Oxygen * Nutrition (feeding tube or CRI solutions) * Intensive care (cardiovascular support, CRI fluids/medications, assistance to stand etc.) * Surgery * Seizure control But needs to be stabilized first!

Question 29

Pre-and dysmature foals.

Answer 29

* Premature: born <320 days of pregnancy * Fair prognosis if pregnancy has lasted more than 300 days. * More than 4 weeks premature usually unable to survive. * Gestational age alone is not adequate to define readiness to birth! * Dysmature: signs of prematurity present but normal length of gestation. * They can also suffer from placental insufficiency. ## Footnote Postmature: post-term foal that has a normal axial skeletal size but is thin to emaciated, generally has long hair, teeth erupted in utero.

Question 30

Dysmature:

Answer 30

signs of prematurity present but normal length of gestation.

Question 31

Postmature:

Answer 31

post-term foal that has a normal axial skeletal size but is thin to emaciated, generally has long hair, teeth erupted in utero.

Question 32

clinical signs of Pre-or dysmature foals (7)

Answer 32

* Small size * Inadequate suckling reflex +/- * Silky hair, floppy ears, domed forehead * General weakness * Unable to rise/stand * Joint and tendon laxity * Incomplete ossification of cuboidal bones (tarsal, carpal)

Question 33

laboratory analyses to do in Pre-or dysmature foals (4)

Answer 33

* Hematology and biochemistry * Reversed ratio of neutrophils:lymphocytes (<1:1; normal 2:1) so Neutropenia * Measure IgG * Look for a signs of sepsis (HIGH RISK)

Question 34

Premature foal: assessment of ossification.

Answer 34

* Tarsal and carpal bones develop mostly during the 4-8 last weeks of pregnancy * The more premature the foal is, the less ossification has occurred. * Very slow ossification after birth * Joints collapse when foal moves → DO NOT allow movement! or else Permanent damage to the joints * Take radiographs ASAP → if no athletic future, owner may choose to euthanize. * Lateromedial views of tarsal and Dorsoplantar/palmar views of carpal bones ## Footnote Box rest if incomplete ossification * Splints * Recheck regularly (x-ray)

Question 35

Adam-Poulos grading

Answer 35

Adam-Poulos grading of incomplete ossification in premature foals. * Grade 1: some cuboidal bones with no ossification * Grade 2: all cuboidal bones have signs of some ossification * Grade 3: bones are small and round * Grade 4: complete ossification ## Footnote lower grade means worse ossification, higher grade is good

Question 36

Main problems in dys-/premature foals. (6)

Answer 36

* Do not stand (and don't allow them too unless splinted) * Do not suckle/have no suckle reflex → hypovolemia, hypoglycemia. * Unable to regulate body temperature + no movement and/or energy from suckling → hypothermia * +/- hypoxia * High risk for FPT → sepsis * Inadequate ossification ## Footnote Treatment/prevention of sepsis * Measure IgG and give plasma if necessary * Broad spectrum antimicrobials

Question 37

Hypovolemia in foals.

Answer 37

Signs of hypovolemia: * Foal is depressed, unable to rise * Prolonged CRT * Distal limbs and ears are cold * Weak peripheral pulses Proper perfusion is a priority! * Prioritize over hypoglycemia or hypothermia * Give Warm isotonic cristalloids (Ringer or NaCl) 20ml/kg as a bolus. * Ringer is preferred * May be necessary to repeat up to 3 times * Assess the foal between every bolus * Every subseequent bolus must be given at slower rate. ## Footnote avg foal birth weight is 45 kg so 900 ml bolus outright and repeated 3 x

Question 38

Describe GLU infusion for Hypoglycemia in foals. How much should blood GLU be? CRI GLU dose?

Answer 38

* Their blood GLU should be Must be between 6-10 mmol/l * Ideally given as a CRI using fluid pump * Start CRI at 4 mg/kg/min * If this is tolerated, increase to 6mg/kg/min and then 8 mg/kg/min * Measure the glucose every 4 hours * May require insulin therapy too. NB Glucose must not be given as a bolus! or else you get hyperglycemia that will be Followed by severe hypoglycemia. * If in the field and bolus therapy is unavoidable (glucose <4,5mmol/l) then, 1% solution (25ml of 40% glucose mixed into 1L of isotonic fluids) given over 30 min. * If recumbent and glucose <3,5mmol/l you Can give 5% glucose. | 400 mg x 25 = 10,000 / 1000 = 10 / 100 = 0.1 = 1% solution ## Footnote Example: 50 kg foal GLU dose 4 mg/kg/min x 50 kg = 200 mg/min x 60 min = 12 000 mg/h 40% glucose = 40 g/L = 400 mg/ml 12 000 mg/h / 400 mg/ml = 30 ml/h Infusion rate = 30 ml/h of 40% glucose

Question 39

Venous access in the foal.

Answer 39

In the clinic, long-term over-the-wire catheters are used in foals (pic). Sterile placement that May need sedation. For stabilization, (traditional) temporary catheters can be used. * Pink (20G) or grey (16 G) small animal catheters * Intraflon etc. Use Jugular or cephalic veins. * Clip and scrub the area even if catheter is temporary.

Question 40

If sedation is needed for catheter placement in the foal... (4)

Answer 40

Sedation of neonatal foal can be performed with: * Diazepam/midazolam +/- butorphanol * 50 kg foal gets 2ml diazepam/midazolam + 0,1-0,2 ml butorphanol This is Sufficient for catheter placements, arthrocentesis, ultrasound, radiographs etc. If you need GA (for example: flushing the joints) * Add ketamine DO NOT USE α2-agonists (detomine, xylazine etc.), acepromazine in the neonatal foal!

Question 41

Describe how to deliver Nutrition to the sick neonatal foal.

Answer 41

Do not allow owners to give milk from the syringe or bottle! * High risk of aspiration Place a feeding tube * Use a Foal feeding tube/large dog feeding tube/stallion urinary catheter. (goes up the nose) * Ideally under the control of endoscope. If endoscope not available, palpate the esophagus to make sure tube is correctly placed. * This is More difficult than in adults, needs experience. May be intolerant of enteral feeding at which point you must switch to Parenteral feeding. * Start with glucose (May also need insulin). * If must be continued for days, lipids and amino-acids are needed.

Question 42

How much and how frequently do foals need feeding when its iatrogenic feeding?

Answer 42

Healthy foals require 20% of their BW/24h. * Sick foals 5-10% of BW. Start gradually * Should give milk every 2 hours. Measure the glucose and USG from the urine. * Can give extra glucose and fluids if feeding is not enough. Check the reflux before giving milk. * When giving milk, use gravity flow. Do not force milk in! * Foal must be sternal or standing during feeding and for 10 min after feeding to Prevent aspiration.