Week 10- Neonatal Therapeutics Flashcards
What are the five core principles of neonatal therapeutic treatment?
- Maintain tissue perfusion, 2. Provide nutritional support, 3. Prevent/treat sepsis, 4. Provide nursing care, 5. Treat primary disease.
What are key signs of hypovolaemia in a neonatal foal?
Obtundation, poor pulse quality, cool extremities, prolonged CRT, pale mucous membranes, poor jugular refill, decreased urination, increased heart rate.
What clinical signs indicate dehydration in a neonatal foal?
Reduced skin turgor, tacky mucous membranes, sunken eyes, reduced corneal moisture, concentrated urine.
What laboratory markers help assess hydration and perfusion status?
Blood lactate, PCV, total protein, creatinine, urine specific gravity, blood pressure.
How should fluid therapy be initiated in an emergency for a 50kg foal?
Give 10ml/kg boluses, reassess frequently; theoretical limit 3–4L; start with 1L Plasmalyte over 30 min.
Why is overuse of crystalloids a concern in neonatal foals?
It may damage the endothelial glycocalyx, leading to increased permeability and worsened systemic condition.
What is the maintenance fluid rate for a neonatal foal?
2–4 ml/kg/hr.
What is the target energy supply rate in sick foals?
4–8 mg/kg/min.
What signs indicate enteral feeding should be avoided in a foal?
Hypothermia, poor perfusion, abdominal distension, lack of borborygmi, colic, reflux.
What is trophic feeding and when is it used?
Feeding tiny milk volumes (e.g., 25 ml every 6–8 hrs) to maintain GI stimulation in foals not tolerating full feeds.
What is the initial nutritional goal in terms of milk volume for a sick 50kg foal?
5% BW/day = 2.5L initially, given in small frequent feeds (e.g., 250 ml every 2 hours).
What is the normal milk intake for healthy foals during the first week?
20–28% of BW/day (e.g., 13–18L for a 65kg foal).
What is the caloric requirement for healthy and sick neonatal foals?
Healthy: 150 kcal/kg/day; Sick: around 50 kcal/kg/day.
What antimicrobial agents are commonly used in neonatal foals?
Ampicillin and amikacin, or penicillin and gentamicin.
What considerations must be taken into account with antimicrobial use in foals?
High body water content, low fat content, immature renal/hepatic function, lower protein binding, reduced hindgut fermentation.
How should passive transfer of immunity be ensured?
Colostrum within first 12 hours or plasma (1L per 2g IgG required).
What is the importance of taking blood cultures in septic foals?
To identify the causative agent and guide antimicrobial therapy.
What are key components of nursing care for a recumbent foal?
Warm, dry, draft-free environment, lubricate eyes, assist to stand and interact with mare every 2 hours.
What is the preferred respiratory support method for foals?
Low flow humidified nasal oxygen (1–15 L/min), maintain in sternal recumbency.
What drugs are used for seizure control in foals?
Diazepam IV or PR, midazolam IV/IM at 0.1–0.2 mg/kg.
What causes respiratory compromise in sick neonatal foals?
Sepsis, compliant chest wall, atelectasis, persistent fetal circulation.
What should be monitored during fluid therapy?
Response to boluses, perfusion parameters, urine output, electrolytes, glucose.
What energy sources can be used intravenously if enteral feeding is not possible?
Parenteral nutrition: IV carbohydrate, protein, and fat.
What is the purpose of the Madigan Squeeze technique?
To mimic the birth canal pressure and aid in treating neonatal maladjustment syndrome.
What are signs of gastric ulceration in foals?
Related to systemic disease, poor perfusion; suspect with signs like colic, bruxism, excess salivation.
How is gastric ulceration managed in neonatal foals?
Sucralfate 20mg/kg PO QID for younger foals; omeprazole 4mg/kg PO SID in older foals.
How does immature organ function affect drug metabolism in foals?
Leads to altered plasma drug concentrations and increased risk of side effects.
What is the typical energy rate for 5% dextrose in a 50kg foal?
240ml/hr provides ~12g/hr = 4 mg/kg/min.
How is sodium overload prevented in fluid therapy?
By avoiding overconcentration of sodium in maintenance fluids.
Why is skin turgor a less reliable indicator in foals?
Foals have higher skin elasticity, making assessment of dehydration harder.
What is the purpose of free water in fluid plans?
To maintain hydration across intracellular and extracellular compartments.
What is the effect of hyperglycemia in sick foals?
Can lead to osmotic diuresis and endothelial damage.
What is the guideline for giving dextrose if glucose monitoring isn’t available?
Add 20ml of 50% glucose to 1L LRS = ~1% solution, administer over 20 minutes.
How often should a sick foal be fed?
Every 2 hours, with close monitoring of tolerance and abdominal comfort.
What is the ideal position for a recumbent foal?
Sternal recumbency to support respiration and prevent atelectasis.
What is the role of pro-kinetic drugs in foals?
Useful for foals with ileus to promote GI motility.
What type of enemas might be needed in neonatal foals?
To relieve meconium retention.
Why do foals require foal-specific drug dosages?
Due to differences in pharmacokinetics compared to adults.
How is ongoing fluid loss accounted for?
Included in fluid therapy as part of ongoing maintenance needs.
What temperature, HR, and RR might a compromised neonatal foal present with?
T ~37.9°C, HR 160, RR 40 – as seen in Felicity 21.
What is the clinical significance of a poor suck reflex in a foal?
May indicate systemic illness, sepsis, or maladjustment syndrome.
Why is glucose monitoring important in fluid therapy?
To avoid hypo- or hyperglycemia and guide dextrose supplementation.
What risks are associated with early enteral feeding in sick foals?
Risk of GI intolerance, reflux, colic, and aspiration.
What is a suitable plan if enteral feeding is not tolerated?
Initiate parenteral nutrition with IV glucose and possibly amino acids and lipids.
What are signs of adequate hydration in a foal?
Moist mucous membranes, normal CRT, good skin turgor, normal urination.
What are key parameters to reassess after a fluid bolus?
Heart rate, mucous membrane color, CRT, temperature of extremities.
How much IgG is provided by 1L plasma?
Approximately 2g IgG.
When should enteral feeding be reintroduced after illness?
Once perfusion improves, no distension or reflux, and normal borborygmi resume.
What is a standard antimicrobial protocol for suspected sepsis in a foal?
IV ampicillin and amikacin, start plasma transfusion, clean environment.
What are the five aims of neonatal therapeutic treatment summary?
Perfusion, Nutrition, Sepsis control, Nursing care, Other supportive treatments.
