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Equine Medicine Final > Septic neonates > Flashcards

Septic neonates Flashcards

1
Q

Normal gestation

A
  • 320-360 days
  • Average is 340 days
  • Mare will typically foal close to the same date with each foal
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2
Q

What can cause gestation in mares to be longer?

A
  • Mares carry colts
  • Mares bred early
  • Older mares
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3
Q

Last 48 hours of gestation

A
  • Development is critical in foals in the last 48 hours
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4
Q

What signals readiness for birth?

A
  • The HPA axis of the foal

- This is why you cannot induce the mare

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5
Q

What influences organ development in the foal?

A
  • Steroid influence

- Another reason why induction of parturition not recommended

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6
Q

What are the three stages of fetal maturation development?

A
  • Premature
  • “Twilight”
  • “Ready for birth”
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7
Q

Premature foals

A
  • generally <310-320 days
  • Immature adrenal axis
  • Poor or no response to ACTH
  • Low white cell count
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8
Q

“Twilight foals”

A
  • 320-330 days
  • Intermediate hormonal development
  • Intermediate WBC counts
  • Intermediate ACTH responsiveness
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9
Q

“Ready for birth” foal

A
  • Mature
  • Fully active and responsive adrenal axis
  • Normal WBC count
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10
Q

How can you tell is a mare is close to parturition?

A
  • Tail head relaxation
  • Relaxation of the perineal area
  • Relaxation of the pelvis
  • Softening of cervix
  • Development of mammary glands
  • “waxing”
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11
Q

Milk electrolytes close to parturition

A
  • Calcium >10mmol/L
  • Potassium >35 mmol/L
  • Sodium <30 mmol/L
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12
Q

Parturition stage 1 length of time

A
  • 1-4 hours
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13
Q

Parturition Stage 1 neonatal position

A
  • I think it rotates so that the head is down with both legs forward
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14
Q

Parturition Stage 1 “Pseudo colic”

A
  • Flehman response
  • Pawing
  • Looking at flank
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15
Q

Stage 2 parturition

A
  • Rupture of chorioallantois or breaking water

- Expulsion of the foal

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16
Q

How long should Stage 2 last?

A
  • Up to 45 minutes, but average is 20 minutes

- NEED to set a timer; if it takes longer than this, there’s a problem

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17
Q

Stage 3 parturition

A
  • Expulsion of fetal membranes
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18
Q

How long should stage 3 parturition take?

A
  • No longer than 3 hours
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19
Q

What happens if stage 3 takes longer than 3 hours?

A
  • Retained
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20
Q

What are risk factors for retained placenta or longer time?

A
  • Dystocia or C-section
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21
Q

What can happen if fetal membranes stay in too long?

A
  • Mare can get extremely toxic

- Probably put them on antibiotics

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22
Q

What’s normal in the first 5 minutes after birth?

A
  • life head, alert, sternal, suckle, reflex
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23
Q

When should the foal be standing by?

A
  • 1-2 hours
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24
Q

When should the foal be nursing by?

A
  • 2-4 hours
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25
Q

When should a feeding pattern be established?

A
  • 12 hours

- Usually nursing 7-10 times an hour

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26
Q

What is the HR of a foal at birth?

A
  • 60-80 BPM
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27
Q

What is the HR of a foal 1 hour after birth?

A
  • Increases to 100 at 1 hour
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28
Q

What is the HR of a foal by 12 hours after birth?

A
  • 80-120 bpm by 12 hours
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29
Q

When should you do a physical exam of a foal?

A
  • Between 12 and 14 hours of age
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30
Q

What should you assess on a physical exam of a foal? (3 very important factors)

A
  • Mental status of the foal
  • Attachment to the mare
  • Nursing well
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31
Q

Neurologic status of a foal

A
  • Awake
  • Somnolent
  • Stuporous
  • Comatose
  • Seizures
  • Focal
  • Generalized: interval, duration, status epilepticus
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32
Q

Mucous membranes on a foal

A
  • Pale, cyanotic, icteric, petechiations, ecchymoses
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33
Q

What does it suggest if a newborn foal has icteric mucous membranes?

A
  • Herpesvirus
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34
Q

Where can you assess mucous membranes of a foal for petechia and echymosis?***

A
  • vulva
  • Ears
  • Gums

CHECK ALL OF THESE PLACES

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35
Q

Respiratory system exam on a foal

A
  • Auscultation
  • Palpation for rib fractures
  • Ultrasound
  • Radiographs
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36
Q

Cardiovascular system exam on a foal

A
  • Mucous membrane color and refill
  • Auscultation
  • Heart rate
  • Murmur (PDA up to 7 days)
  • Arrhythmia
  • Pulse quality
  • MAP >60 mmHg
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37
Q

What should the 1 minute post foaling temp be?

A
  • 99-100F
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38
Q

What should the 12 hour post foaling temperature be?

A
  • 100-102F
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39
Q

When should you suspect a problem for foaling temperature at 12 hours post foaling?

A
  • Below 100 or above 102
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40
Q

Umbilicus examination

A
  • Palpate for abnormalities
  • Dip with dilute chlorhexidine
  • Ultrasound
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41
Q

Ultrasound findings of the umbilicus

A
  • Stump <2 cm
  • Vessels <0.5 cm
  • Urachus (don’t want to see it patent)
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42
Q

Potential problems with umbilicus

A
  • Infection
  • Hernia
  • Patent urachus
  • Urachal rupture
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43
Q

Urinary tract exam in foals

A
  • intact bladder
  • Can rupture during parturition
  • Colts more likely than filly
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44
Q

Why are colts more likely to have a bladder rupture during parturition?

A
  • Narrow pelvis

- Often have a full bladder when born, and colts have a big bladder going through their narrower pelvis

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45
Q

When should colts typically urinate by?

A
  • 6-8 hours of age
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46
Q

When should fillies typically urinate by?

A
  • 12-14 hours of age

- Often expelled as it was born

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47
Q

GI tract exam in a foal

A
  • Meconium (do they have tiny black feces?)
  • Diarrhea
  • Abdominal distension
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48
Q

When should meconium pass by?

A
  • 12-14 hours after parturition
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49
Q

Reproductive tract exam in a foal

A
  • Scrotal hernia
  • Inguinal hernia
  • Congenital vs ruptured tunic
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50
Q

Ophthalmology exam on a foal - why important?

A
  • Septic foals often have a problem with the eyes
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51
Q

Ophthalmology exam on a foal possible findings

A
  • Entropion (dehydration)
  • Corneal ulcers
  • Periocular trauma
  • Uveitis
  • Congenital
  • Cataracts**
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52
Q

Musculoskeletal exam findings on a foal

A
  • Flexural deformities
  • Joint effusion - always palpate
  • Angular limb deformities
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53
Q

Immaturity/dysmaturity signs

A
  • Floppy ears
  • Tendon laxity
  • SIlky hair coat (if immature, premature, or dysmature)
  • Carpal and tarsal bones lack of ossification
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54
Q

What does prognosis depend on carpal and tarsal bone ossification?

A
  • How well ossified they are

- She will often take an x-ray pretty quickly to get a sense of prognosis

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55
Q

Dysmature foal

A
  • Dysmature if it’s 340 days or older and has characteristics of floppy ears
56
Q

Normal PCV for a foal

A
  • 34-44% at birth
57
Q

What happens to the PCV of a foal over the first week?

A
  • Decreases over the first week
58
Q

What is suggested if the PCV of a foal is >45% when born?

A
  • May indicate in utero hypoxia
59
Q

What are two differentials if a foal is anemic?

A
  • Neonatal isoerythrolysis

- blood loss (when foals are born, they can bleed for awhile from the umbilical site)

60
Q

Normal TP at birth

A
  • Less than 5.0g/dL
61
Q

What should happen to TP after birth?

A
  • Increases with passive immunity
62
Q

What is suggested if TP and globulins are high at birth?

A
  • In utero infection
63
Q

What is suggested if the TP is low at 12-14 hrs after birth?

A
  • Failure of passive transfer

- Protein loss through GI or kidney

64
Q

Hematology of a foal with in utero infection?

A
  • Leukocytosis
  • Neutrophilia/neutropenia
  • Band neutrophils
  • Lymphopenia
  • Fibrinogen should normally be less than 200g/dL
65
Q

What is suggested if fibrinogen is greater than 200g/dL?

A
  • In utero infection
66
Q

Biochemistry panel “normal” elevations

A
  • Alkaline phosphatase can be normal up to 2835 for a few weeks
  • Bilirubin may go as high as 5.5mg/dL due to lysis of foal erythrocytes in first week of life
  • Phosphorus elevation (growing)
67
Q

Biochemistry panel “abnormal” elevations

A
  • Creatinine
  • Elevated BUN
  • Lactate
68
Q

What is suggested if the foal has an elevation in creatinine?

A
  • Consider placental insufficiency
69
Q

What is suggested if the foal has an elevation in BUN?

A
  • Consider protein catabolism from starvation in utero

- Mare had colitis or something

70
Q

What is suggested if the foal has an elevation in lactate?

A
  • Watch trend
  • Problems with perfusion and utilization
  • Not too concerned if high at birth but goes down
71
Q

What is the most common problem in neonates?

A
  • Neonatal septicemia
72
Q

Morbidity rate of neonatal septicemia

A
  • High
73
Q

What factors are key to success of treating neonatal septicemia?

A
  • Early ID and management
74
Q

Risk factors for neonatal septicemia

A
  • FPT or partial FPT
  • Perinatal stress
  • In utero hypoxia
  • Prematurity
  • Poor management: unsanitary conditions, poor ventilation, exposure to primary pathogens
75
Q

Neonatal risk factors for septicemia

A
  • Stress
  • Prematurity/dysmaturity
  • Prolonged gestation
  • Twin gestation
  • Meconium staining
  • FPT
  • Perinatal asphyxia syndrome
76
Q

Maternal risk factors for septicemia

A
  • Old age (colostrum not good)
  • Illness
  • Colic
  • Loss of colostrum
  • Stress
  • Prolonged gestation
  • Dystocia
  • Poor nutritional status
77
Q

In utero infection CBC findings

A
  • Leukocytosis and high fibrinogen at <24 hours

- Some foals born from dams with placentitis may not be septic but will have elevated WBC count for 2-4 days

78
Q

In utero infection signs

A
  • +/- uveitis
  • changes on CBC
  • May be slightly premature or thin as a result of inflammatory cytokines (IL-1, IL-6, TNF)
79
Q

What is usually the etiology of in utero infections?

A
  • Bacterial placentitis usually the etiology
80
Q

Treatment of SIRS of Sepsis in the fetus

A
  • Influence development of SIRS in the fetus by treatment of the mare and placental inflammation
  • Antimicrobials
  • Pentoxyfylline
  • NSAIDs (flunixin meglumine or Firocoxib)
  • Altenogest
  • Antioxidants (Vitamin E)
81
Q

Pentoxyfylline

A
  • Drug used for laminitis
  • Makes red cells more flexible
  • Decrease production of IL6, IL1, TNF
82
Q

Altenogest function

A
  • Decrease myometrial response

- Progesterone

83
Q

What two events must have occurred for a postpartum infection to have occurred?

A
  • Exposure to microbes

- Defense response inadequate

84
Q

Environmental risk factors for postpartum infections

A
  • Nosocomial infections
  • influence of antimicrobial agents altering flora
  • Stall vs pasture - less incidence of diarrhea, same incidence of septicemia
85
Q

immune risk factors for postpartum infections

A
  • Failure of passive transfer
86
Q

Organ dysfunction risk factors for postpartum infection

A
  • Usually effect of perinatal asphyxia
  • Weakness
  • Abnormal intestinal motility
  • Inadequate or abnormal nutrition
  • Red bag (??)
87
Q

Prevention of exposure to environmental pathogens

A
  • Good management is most important
  • Clean stalls
  • Hygiene around foaling time
  • Cleaning mare’s udder and perineal regions
  • Umbilical care
88
Q

Colostral management

A
  • Checking mare to determine if adequate mammary development
  • Testing colostrum
  • IgG evaluation in foal
89
Q

What should specific gravity of colostrum be?

A
  • > 1.060
90
Q

When should you perform IgG eval in a foal?

A

12-14 hours of age

91
Q

What is considered adequate transfer of immunity?

A
  • > 800 or >400

- Everyone agrees that <400 is inadequate

92
Q

What influences production of colostrum?

A
  • Produced under hormonal influence last 2-4 weeks of gestation
93
Q

What does colostrum contain?

A
  • Contains immunoglobulins (primarily IgG type) concentrated from mare’s blood as well as other factors important in immunity
94
Q

Characteristics of colostrum

A
  • thick, yellow sticky
95
Q

When is colostrum replaced by milk?

A
  • 12-24 hours after foaling
96
Q

Special cells to absorb IgG in the neonate

A
  • Neonate has specialized cells in the small intestine to absorb large molecules
97
Q

How do neonates absorb antibodies?

A
  • pinocytosis

- Not specific

98
Q

When are the specialized cells replaced?

A
  • by 36 hours of life
99
Q

When is the peak of colostrum absorption?

A
  • Shortly after initial ingestion

- Usually around 2 hours of age

100
Q

When is the ability to absorb colostrum decreased?

A
  • 6-8 hours of age
101
Q

When is the ability to absorb colostrum gone?

A
  • 18 hours
102
Q

What is optimum amount of colostrum to absorb?

A

2-4 L

103
Q

Colostrum replacement

A
  • No replacement better than good quality, tsted colostrum
104
Q

Colostrum banks:

Which antibodies does colostrum from a bank usually test negative for?

Which viral disease is screened out as well?

A
  • Tested negative for Aa and Qa antibodies against a bank of RBCs
  • From EIA negative donors
105
Q

Oral supplements as substitute for oral colostrum

A
  • Rarely achieve sufficient plasma levels of IgG
106
Q

When does neonatal sepsis usually occur?

A
  • Usually <7 days of age

- Can be later

107
Q

Pathogenesis of sepsis

A
  • Bacterial infection

- Can progress to Systemic Inflammatory Response Syndrome –> sepsis –> septic shock –> MODS –> DEATH

108
Q

What do older foals tend to get instead of systemic sepsis?

A
  • Localized infections
109
Q

Onset of sepsis

A
  • Variable but typically <7 days
110
Q

When does acquired post natal sepsis usually occur?

A
  • Typically 3-4 days of age

- Can see as early as 24 hours of age

111
Q

What gram stain are most common pathogens in neonatal sepsis?

A
  • Gram negative

- Can be mixed

112
Q

When do Actinobacillus sepsis infections usually occur?

A
  • 24-48 hours old
113
Q

Most common Gram negative pathogens

A
  • E. coli

- Klebsiella

114
Q

Most common Gram positive pathogens

A
  • Streptococcus
  • Staphylococcus
  • Less common overall
115
Q

Recognition of sepsis in neonate early signs

A
  • Septic until proven otherwise
  • Early signs are weakness, somnolence, lethargy, decreased suckle
  • Petechiae and microvascular injury
  • Discolored mucous membranes due to poor microvascular flow
  • Icterus as endotoxin impairs bile flow in the liver
  • Hypotension/poor arterial pulses/cold peripheral skin
116
Q

What is one of the most important signs of sepsis?

A
  • DECREASED SUCKLE
117
Q

What are five quick things to indicate of a foal isn’t suckling or dehydrated?

A
  • Udder distension/streaming milk
  • CRT
  • Entropion
  • Urine specific gravity (mare’s milk and colostrom often have low USG so should be <1.008 in the first 48-72 hours)
  • Hypoglycemia
118
Q

History of mare that would suggest neonatal sepsis

A
  • Placentitis
  • Vulvar discharge
  • Dystocia
  • Prematurity
119
Q

CBC results in neonatal sepsis

A
  • Leukopenia/neutropenia
  • Left shift
  • Toxic changes
120
Q

Chemistry results in neonatal sepsis

A
  • Hypoglycemia

- Elevated lactate

121
Q

Blood culture results

A
  • Isolation of microorganisms
  • 26-28% in some NICU’s
  • New study showed healthy foals can be bacteremic in the first 24-48 hours of life
122
Q

Interpretation of positive blood culture?

A
  • Iffy

- If they’re showing signs of sepsis, they are probably septic

123
Q

Clinical findings of neonatal sepsis

A
  • Fever/hypothermia
  • Petechiae
  • Scleral injection
  • Obtundation/coma/seizures
  • Anterior uveitis
  • Diarrhea
  • Pneumonia
  • Swollen joints
124
Q

Diagnosis of neonatal sepsis

A
  • history
  • Clinical signs
  • Blood culture
  • Radiographs
  • Ultrasound
  • Sepsis score
  • Joint tap
125
Q

Sepsis score categories

A
  • History (peripartum events)
  • Physical exam (signs of infection; foal’s condition)
  • CBC (markers of sepsis)
  • Chemistry panel
  • Indicative of organ or systemic disease
  • Helps understand parameters that indicate sepsis
  • Helps predict likelihood of sepsis
126
Q

What score on the sepsis score usually correctly predicts sepsis?

A
  • Score of 12 or more

- not 100% by any means

127
Q

Initial stabilization of septic neonates

A
  • Heat (prevent hypothermia)
  • Respiratory support: nasal oxygen, caffeine
  • Eye care: correct entropion
  • Fluid therapy: over the wire catheter (blood culture, give glucose, administer plasma)
  • Control seizures with diazepam
128
Q

Antimicrobial selection in septic neonates

A
  • Broad spectrum combo
  • Penicillin (Gram positive) + aminoglycoside (gram negative)
  • Do not use nephrotoxic drugs if birth asphyxia suspected
  • Ceftiofur alone or in combination
  • Reserve advanced antimicrobial drugs (e.g. iminpenim) for severe sepsis and susceptibility known
129
Q

Monitoring for nephrotoxic abx

A
  • If creatinine is WNL you can use, but make sure you monitor it over time
  • Pay attention to hydration and albumin concentrations
130
Q

Adverse effects of antimicrobials

A
  • Avoid nephrotoxic drugs
  • Long term can alter normal microbiome
  • Predispose to fungal overgrowth (Candida)
  • Usually seen in very sick weak foals, not on normal nutrition
131
Q

Nutrition of septic foals

A
  • Enteral if possible
  • If possible birth asphyxia consider parenteral nutrition
  • Pass small bore nasogastric tube to be left in place
132
Q

What % of body weight to healthy foals eat?

A
  • up to 25%
133
Q

What % of body weight should be given to septic foal initially?

A
  • 10% of amount initially or less
134
Q

Other nursing care considerations when feeding a septic foal

A
  • Make sure in sternal
  • Frequent feedings q2 hours
  • Sick foals have a decreased RER
135
Q

Treatment summary for septic foal

A
  • Supportive care
  • Fluid therapy
  • +/- pressor
  • +/- physiologic doses of corticosteroids
  • Plasma
  • Oxygen insufflation
  • Antimicrobials
  • Nutritional support

Equine Medicine Final (10 decks)

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