Unit 3 - Neonatal 2 Flashcards
What is a pre-mature foal?
Physically a premature birth date
What is a dysmature foal?
a normal gestational length but clinical signs of prematurity
What is a post-mature foal?
A physically late birth date with atypical development
True or False: Premature and dysmature foals have the same clinical signs
True
What may you see on PE in a premature or dysmature foal?
Short hair coat, joint laxity, floppy ears, and domed head
What bone/joint abnormality are premature/dysmature foals at risk for?
Incomplete ossification of their cuboidal bones
What will a postmature foal look like on PE?
Shaggy hair coat and contracted tendons
What comorbidities are premature/dysmature/postmature foals at risk for?
Failure of passive transfer, sepsis, and neonatal maladjustment syndrome
Foals rely on colostrum ingestion and absorption for antibody acquisition for the first 4 ______ of life.
weeks
How does the GI tract absorb immunoglobulins from colostrum in the foal?
pinocytosis
When does maximum absorption of the colostrum occur in a foal?
Within the first 8 hours of life
When does absorption of colostrum decrease to almost no absorption?
by 24 hours
When should you test for passive transfer in a foal?
At 12-24 hours of age
What levels of immunoglobulins indicate normal, complete passive transfer?
> 800 mg/dl
What levels of immunoglobulins indicate partial failure of passive transfer?
400-800 mg/dl
What levels of immunoglobulins indicate complete failure of passive transfer?
<400 mg/dl
What are foals with < 800 mg/dl of immunoglobulins at risk for?
generalized sepsis and/or localized infections
How do you treat a foal with failure of passive transfer before 8-24 hours post parturition?
Give enteral supplementation - frozen colostrum or commercial products
How do you treat a foal with failure of passive transfer after 24 hours post parturition?
Intravenous plasma transfusion - typically 1-3 liters are needed
What is sepsis?
bacteremia and systemic clincal signs
What are the risk factors for sepsis?
Poor intrauterine life, partial or complete failure of passive transfer
What are the clinical signs of generalized sepsis?
Lethargy, decreased nursing, increased time spent laying down, injected mucus membranes, petechia, fever OR hypothermia, and hyperemic coronary bands
What clinical pathologic changes may you see with generalized sepsis?
Hypo or hyperglycemia
Leukopenia, toxic changes, and degenerative left shift
What clinical signs can be associated with localized sepsis?
Septic arthritis/synovial structures Osteomyelitis Uveitis Septic umbilicus Pneumonia Meningitis
Note- The region affected will have the clinical sign
True or False: Hypoglycemia in foals should be treated as sepsis unless proven otherwise.
True
When should you treat for sepsis?
Timing is everything - when in doubt treat
How should you treat sepsis in a foal?
Broadspectrum antimicrobial therapy and supportive care
What supportive care is recommended for treatment of sepsis in a foal?
Nursing care for skin/bed sores, nutritional support, fluid support - be on the look out for localization
What condition that a mare can have during parturition should make you worried about sepsis?
placentitis
What is the hypothesis for the cause of neonatal maladjustment syndrome (NMS)?
Hypoxic insult prior to or at birth (placentitis, prolonged delivery)
Where does NMS manifest?
Central nervous system, GI tract, renal
True or False: If foals are normal at birth, they are not at risk for NMS.
False - They can be normal at birth and then develop clinical signs within the first 24 hours
What does NMS cause in the GIT?
Ileus which results in gastric reflux and colic
Ischemic damage to the mucosa
What does ischemic damage to the mucosa result in?
Malabsorption - diarrhea
Lactose intolerance
Translocation of bacteria
What renal manifestations are associated with NMS?
Acute kidney injury and vasomotor nephropathy (poor fluid flow)
What signs are associated with AKI in a foal with NMS?
Isosthenuria, azotemia, and oliguria/anuria
What type of foals should make you suspect that NMS is going on?
Foals that are not meeting their milestones
Foals that are not suckling appropriately
Foals that are having seizures
What is the prognosis for uncomplicated cases of NMS?
Good prognosis - they resolve in 72 hours
How do you treat the CNS manifestations of NMS?
Ensure that the foal is getting adequate nutrition, hydration, and is safe
Foster the normal maternal bond and maternal behavior
Seizure control
How do you treat the GIT manifestations of NMS?
If ileus - GI rest or careful feeding
Lactase supplementation
Colitis - prophylactic abx for bacterial translocation and fluid therapy
How do you treat the renal manifestations of NMS?
Thoughtful fluid therapy and judicious use of nephrotoxic medications
If a foal has its back hunched that indicates that it is straining to _______. If a foal does not have its back hunched that indicates that it is straining to ______.
Defecate; urinate
How is meconium impaction diagnosed?
History, clinical signs, digital rectal exam, and radiographs
What clinical signs are associated with meconium impaction?
Straining to defecate, colic signs in the first day of life - all combined with not seeing a lot of meconium
How is meconium impaction treated?
Enemas, pain control, and supportive care`
What enemas can be given to a foal with meconium impaction?
Fleet enema - no more than 1 per 24 hours
Soapy water enema
Acetyl cysteine retention enema
What pain control can be given to a foal with meconium impaction?
Flunixin meglumine and butorphanol
What supportive care is recommended for foals with meconium impaction?
Ensure adequate IgG, hydration, and nutrition
What is the pathophysiology of neonatal isoerythrolysis?
Mare develops anti-RBC antibodies to the foal’s blood type
Anti-RBC antibodies are ingested by the foal
Qa and Aa are the most common
What is the signalment for neonatal isoerythrolysis?
Typically it occurs in foals 2-5 days of age
What clinical signs are associated with neonatal isoerythrolysis?
Icteric mucus membranes, lethargy, and tachypnea
What will you see on bloodwork in patients with neonatal isoerythrolysis?
Low PCV (5-20%), normal protein, and significant hyperbilirubinemia
How is neonatal isoerythrolysis diagnosed?
Clinical signs, signalment, and confirm with agglutination or lytic tests
How do you treat neonatal isoerythrolysis?
Supportive care, blood transfusion if needed
How do you prevent neonatal isoerythrolysis?
Prevent future foals from consuming colostrum from that mare
What blood should you not transfuse into a foal with neonatal isoerythrolysis?
Whole blood from the mare or blood from the stallion
What do you need to do to blood prior to transfusion of a mare’s blood to its foal with neonatal isoerythrolysis?
Wash the blood from mare to remove the globulins
If you chose not to use blood from the mare, what blood can be transfused to a foal with neonatal isoerythrolysis?
Universal donor (Qa, Aa negative)
