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Foal Emergencies

 
The signs of illness in foals are often vague and nonspecific.  This means that you should be familiar with normal behavior in order to recognize problems early.  Dramatic changes in a foal's condition can occur very rapidly.  The wait and see approach can be disastrous when dealing with the neonate.  A short time delay in the institution of therapy can make the difference between success and failure. It is my opinion than any foal which appears ill constitutes an emergency.  Below are listed the normal parameters for foals in the immediate post-partum (post foaling) period.

NORMAL PARAMETERS

Gestational age: 341. Range = 315 - 365 days.
Time to sucking reflex: Ave. 20 minutes post-foaling.
Time to standing: Ave. 57 minutes, range 15 - 165 minutes.
Time to nursing: Ave. 111 minutes, range 35 - 420 minutes.
Body temperature: First four days: 99 - 102F.
Heart rate: Ave. first five minutes: 70 bpm
Respiratory rate: First 15 minutes: 60 - 80 bpm, then 20 - 40 bpm.
First urination: Ave. 8.5 hours after birth, colts earlier than fillies.
Meconium passage (first stool): Within first 24 hours.
Menace response (Blink response): Not present until 2 weeks of age.


NORMAL GUIDELINES USED TO ASSESS NEONATAL VIABILITY

Adaptive response Time Elapsed Since Birth
Normal respiratory and cardiac rhythm Within 1 minute
Righting reflexes established Within 5 minutes
Sucking reflex established Within 30 minutes
Attempts to stand Within 60-120 minutes
Ability to stand unassisted Within 60-180 minutes
Nurses from udder Within 60-180 minutes
If any of these parameters appear outside the given normal range, either high or low, considered it abnormal and it is time to call your veterinarian.

Some abnormalities which can give you an indication that things are amiss include:
Increased passive range of motion of joints.
Tendon contracture. Flexor tendon laxity (walking on their fetlocks).
Angular limb deformities (eg.knock knee'd).
Entropion (lower eyelid rolled under).
Tipped ears, velvety hair coat (prematurity).
Heat, swelling, or pain at joints or physes (growth plate).
Fractured ribs associated with foaling (rapid, shallow breathing).
Umbilical or inguinal (scrotal) hernias.
Cleft palate (milk running out of the foals nose as it nurses).
Scoliosis (curved), kyphosis (flexion), or lordosis (extension) of the spinal column.
Injected (blood shot) or icteric (yellow) sclera (whites of the eyes).
Straining to defecate or urinate.
Red line around the coronary band (will only be evident on white footed animals).
Swollen, moist, leaking umbilical cord.
Foal wanders away from the mare or in unaware of the mare in the stall.
Poor suckle reflex.
Placenta is thickened, discolored.
While we spend alot of time looking at the foal, don't forget that the mare can give you an indication that the foal is becoming ill before the foal shows a significant change in character. Examine the udder, milk, and vulva for signs of disease or infection. A full tight udder indicates a foal that isn't nursing. Malodorous uterine discharge may indicate the foal has an infection which developed in utero.


CONDITIONS ASSOCIATED WITH HIGH RISK NEWBORN FOALS

MATERNAL CONDITIONS:

Purulent vaginal discharge Fever
Hydrops allantois General anesthesia
Colic surgery Endotoxemia
Excessive medication History of previous abnormal foal
Premature lactation Poor nutritional status
Prolonged transport prior to foaling


CONDITIONS OF LABOR OR DELIVERY:

Premature parturition Abnormally long gestation
Prolonged labor Induction of labor
Dystocia Early umbilical cord rupture
C-section


NEONATAL CONDITIONS:

Meconium staining Placental abnormalities
Placentitis Twins
Orphan Inadequate colostral intake\
Immaturity/prematurity Exposure to infectious disease Trauma


SPECIFIC DISEASES OF THE EQUINE NEONATE

It is obvious that we can not possibly go over every disease condition which constitutes an emergency in one web page. It is likely that the physical abnormalities associated with trauma constitute an emergency and need not be covered, except your initial management until the vet arrives. Certainly there are going to be conditions which arise in which nothing can be done, except euthanasia. This is something horse owners deal with on a day to day basis, and not something we take lightly. I will outline some conditions which may not be treatable medically or surgically, briefly, and then discuss some of the more common diseases seen.

Untreatable diseases:

Microphthalmia/Anophthalmia
Ventricular septal defect
Trilogy/Tetralogy/Pentalogy of Fallot (multiple cardiac defects)
Atresia coli*
Atresia ani*
Choanal atresia* Fractured spine
Fractured femur
Premature foal (less than 300 days into gestation)*
* Constitute diseases which may have a treatment option, however, the prognosis going into treatment is grave. Lacerations and long bone fractures can initially be managed with pressure wraps and support bandages until the vet arrives. Unless you have specific questions we won't go into this further.


FAILURE OR PARTIAL FAILURE OF PASSIVE TRANSFER OF THE FOAL

In order for the foal to fully fight off infection early in its life, it must ingest colostrum (first milk) which contains the antibodies which protect the foal from many diseases. There are special cells in the gastrointestinal tract which will absorb these antibodies. These special cells are replaced within the first 36 hours of life, so it is essential that the foal nurse within the first 6-8 hours of life, the time of peak absorption. Antibody absorption decreases rapidly afterwards. We like to see the foal nurse within 2 hours and certainly by 3 hours after birth. The earlier the foal nurses, the more antibodies it absorbs, the more protected it becomes. These foals do not show any evidence of disease and a diagnostic test is the basis of
detecting the disorder.


CAUSES OF FAILURE OF PASSIVE TRANSFER

Premature lactation (loss of colostrum before birth).
Inadequate colostrum production by the mare or poor colostral quality.
Delayed onset of sucking (foal that is slow to get up).
Malabsorption by the small intestine.
Prematurity: <320 days, the foal may be capable of absorption, but colostrum may not have formed.
Detecting 800 mg/dl of IgG in the foal is considered to be the minimum concentration for adequate passive transfer. Less than 400 mg/dl is considered to be complete failure of passive transfer. These foals are considered to be at greatest risk for any development of infectious disease. There are no specific abnormal clinical signs associated with failure of passive transfer and the foals act normally until they develop some disease. How do you tell if the foal got a good quality colostrum
and an adequate amount?

If the mare dripped milk for any appreciable time before foaling, assume that she has lost her colostrum. If you notice this happening, milk her out and save that milk. Freeze it. Would I collect the milk till she foals, you bet. If the mare doesn't drip milk before foaling, collect some of the colostrum and measure the specific gravity. An device used to measure antifreeze in your car radiator will suffice. If all the balls float, you can assume the colostrum to be of good quality. This corresponds to a specific gravity of about 1.060. Of course, this is a rough estimate. Once the foal nurses, you can measure the IgG content at 18-24 hours after the foal nurses. Several tests are available, some even foal side. The Cite Test can be performed on whole blood, plasma, or serum and can be done on the
farm.

Treatment of this disorder depends upon when you detect a problem. If you know the foal hasn't nursed and it is less than 12 hours old, oral administration of colostrum ( 3 liters) is the treatment of choice, followed by testing for adequate absorption. If the foal is over 24 hours old, a plasma transfusion is required to bolster the IgG concentration. The foal may need between 1 - 3 liters. Plasma administration should take place over several hours, however, it may not be practical to administer it this slowly. Adverse transfusion reactions include shivering, elevated respiratory rate, anaphylactic reactions have occurred and resulted in death.


NEONATAL ISOERYTHROLYSIS (NI)

This is a severe hemolytic disease caused by incompatibility between the mare's and stallion's bloodtype. It is rarely seen in maiden mares as the mare must be sensitized to antigens from the stallion's red blood cells (RBC) in order to produce antibodies against them. These antibodies are then concentrated in the colostrum of the mare and passed on to the foal after birth. If the foal has inherited incompatible RBC antigens from the stallion and ingests colostrum containing antibodies directed against those antigens, NI may ensue. Mares may become sensitized by previous blood transfusion with blood of a similar type to the stallion or by transplacental RBC leakage during pregnancy.


CLINICAL SIGNS:

Foal born healthy, with onset of the disease between 6 - 96 hours of age.
Severity of signs is dose dependant, peracute (found dead) to few clinical signs.
Packed cell volume (PCV) <20%.
Pronounced icterus (yellow, jaundice) of mucous membranes.
Tachycardia (elevated heart rate).
Progressive weakness.
These foals usually are not febrile (fever) and may or may not exhibit hemoglobinuria (dark colored urine).

The diagnosis is based upon clinical signs and cross-match the mare and foal.

Treatment consists upon the severity of clinical signs. If diagnosed before 24 hours of age, muzzle the foal, milk out the mare and feed the foal colostrum from another source. If the PCV is <15% or the foal is very weak, keep the stress to a minimum. Blood transfusion will also be required at this point. The mares washed RBC's provide the best source. If this is impractical to accomplish, an aged gelding who has not had a blood transfusion is an alternative source. Those horses known to be A- and Q-type negative are good blood donors. Other supportive care may be required, consult your vet. Look for other problems.


NEONATAL MALADJUSTMENT SYNDROME (Barkers, Dummies, Wanderers)

A noninfectious central nervous system disorder of neonatal foals associated with behavioral abnormalities. The syndrome usually is first seen anytime after birth to 24 hours of age. These foals may be completely normal at birth, had a normal gestation and parturition. The foaling may have been difficult or the foal may have suffered some hypoxic (low oxygen) episode.

The clinical signs associated with this disease relate to derangements of cerebral function or spinal cord disease, or both.

Central signs:

Loss of suckle reflex
Aimless wandering, may appear blind
Hyperexcitable with jerky stiff movements or unresponsiveness
Extensor spasms of neck, limbs, paddling
Chomping or teeth grinding
Abnormal vocalization
Anisocoria (one dilated and one constricted pupil)
Abnormal respiratory patterns
Hypothermia (low body temperature), acidosis
Coma, death
Spinal cord signs:

Weakness
Ataxia (incoordinated)
Depressed local reflexes
This disease needs to be differentiated primarily from septicemia. Often times these syndromes appear similar. A complete blood count will help differentiate the two diseases. Serum biochemistry panel may also show abnormalities in septic foals where NMS foals will be normal.

Treatment:

Control convulsions
Maintain body temperature, hydration, caloric intake, electrolyte and acid-base balance, and blood glucose.
Oxygen therapy as needed
CNS edema
Ensure adequate passive transfer
Physical therapy
Broad spectrum antibiotics.

This is a multisystemic disease and many of the patients concurrently have ongoing sepsis, failure of passive transfer, enteritis, ulcers, etc.


SEPTICEMIA

This is probably the leading cause of death in neonatal foals. It usually involves a gram negative bacteria which gains access to the circulatory system. The primary routes of infection are the respiratory tract, gastrointestinal tract, and umbilical cord. It may be acquired in utero or in the immediate post-partum period. These foals may be born normal or are weak right after birth. If they appear normal at birth, they may deteriorate in a matter of hours. This out of all the diseases discussed previously is truly an emergency and needs attention as soon as it noted the foal to be ill.

Septicemia s a disease involving bacteria or toxins in the blood stream or tissues. A number of bacteria that normally inhabit the skin of horses or that are present in the environment can cause septicemia. Bacteria gain access to the foal through the umbilical stump, intestinal tract or lungs. Septicemia usually occurs within three to four days after birth.

Some infections develop in utero from passage of bacteria across the placenta and are present at birth. The infection can spread to other organs, such as the lungs, intestinal tract, bones/joints, liver, kidneys and central nervous system (table 1). Previously this condition was known as "navel ill" or "joint ill”.

The death rate from septicemia ranges from 30 -75 per cent of affected foals, indicating the seriousness of this disease.

Clinical signs are often subtle and progress rapidly. By the time clinical signs are observed, the foal can be critically sick. Symptoms are depression, weakened suckle activity, diarrhea and excessive sleeping or resting. Foals may be too weak to nurse and may appear unaware of their surroundings. They may act sluggish when attempting to nurse and there may be milk on their forehead. If a mare's udder is full and hot, it is a sign that the foal is sick and not nursing properly. The foal's nostrils may be flared, and the respiration rate may be increased. Foals often become dehydrated. Fever occurs in less than 50 percent of the cases. The foal may be reluctant to move, as joint pairs are usually affected and may be hot, swollen and painful. Infection may move from joint to joint. However, foals can die from septicemia before any signs of joint involvement are noticed. The navel stump, if infected, can be hot, swollen and have periodic discharges. However, it may look normal but have an internal infection of the stump. Ultrasound can be used to diagnose internal umbilical infections. All lameness and swollen joints of affected foals should be x-rayed.

Foals may appear to recover, but symptoms can occur again in eight to twelve months. Chronic cases cause joint enlargements, arthritis and potential damage to the growth plates. Complications have been observed in foals with septicemia, such as pneumonia, meningitis and brain or spinal cord hemorrhage.

For survival of the foal, it is critical to recognize septicemia before life-threatening signs occur.

It is important to keep good records on each mare's pregnancy, foaling process and the post-foaling health of the mare and the foal. Problems that should be considered as potential risk factors predisposing foals to septicemia are previous abortions in the dam or a stillbirth, twins, premature foals, smaller than normal foals or mal formed foals. Mares with chronic illness, that are malnourished during pregnancy or have a loss of colostrum may produce at-risk foals. Dystocia, induced birth, cesarean section, premature placental separation, premature rupture of placental membranes or death of the mare are risk factors.

Prematurity, postmaturity or being small at birth has been known to impair a foal's immunity. Foals that require resuscitation after foaling or that are stained with meconium are at a greater risk of septicemia, because of possible aspiration of meconium, poor lung inflation and inability to stand and suck colostrum normally. Foals without a normal suckling reflex, that do not stand and nurse within two or three hours of birth or that have any other behavioral or physical abnormalities are at risk of septicemia. Of course, improper or poor umbilical stump disinfection or inappropriate on-farm use of antibiotics can cause septicemia.

Failure of passive transfer (FPT) is a failure to acquire adequate antibodies from colostrum, which often results in an infection. This is a serious problem in mares that graze endophyte-infected tall fescue during the last 30 days of pregnancy. Other causes of FPT are failure of lactation in maiden mares, leaking of colostrum prior to foaling, failure of the foal to ingest adequate colostrum in the first 12 hours of life, inadequate immunoglobulin content of colostrum or inadequate immunoglobulin absorption by the foal.

Antibiotics help reduce the spread of septicemia. When a foal first becomes sick and lethargic, contact your veterinarian immediately.

Preventing Septicemia
The mare should be placed in the foaling stall 30 days before foaling to allow her to produce antibodies against pathogens common to that environment. Disinfect foaling stalls before they are used, and thereafter clean them twice daily. Wash the mare daily to reduce bacterial buildup from the stall on her haircoat and perineum. A thorough grooming should be done each day.

As soon after birth as possible, the foal's navel stump should be treated to prevent entry of bacteria into the foal. In the past, iodine was normally used. Research from the University of California has shown that the best treatment of the newborn foal's navel stump is chlorhexidine (Nolvasan). Dilution of one part of Novalsan to four parts of water produces the correct 0.5 percent chlorhexidine solution.

Do not allow the foal to nurse until the following are done: 1) completely wash the mare's udder, perineum and rearquarters to remove any fecal bacteria that the foal may come into contact with when it seeks to nurse. Use a large volume of water and soap, then thoroughly rinse and dry the mare; 2) milk 2 - 4 ounces of colostrum from the mare's clean udder and bottle feed the foal before it rises to nurse when it has a sucking reflex.
If the mare does not have colostrum, use colostrum from a colostrum bank.

If the foal is weak, tube feed it within an hour of birth with 6 - 8 ounces of colostrum. With orphan foals, feed them with a bottle or from a pan until they consume 10 percent of their body weight.

For foals born without observation that did not receive the above precautions, antibiotic therapy may be necessary. Owners are cautioned not to use antibiotics without consulting their veterinarian.

In the treatment of septic foals, it is imperative that they be kept in a clean environment. They should lie on their chest, not on their side and should be protected from injuries.

The clinical signs associated with septicemia include:

All ten signs listed under NEONATAL MALADJUSTMENT SYNDROME
Bright red mucous membranes (gums and conjunctiva)
Cyanotic (bluish) mucous membranes (gums)
Hemorrhages present on the gums
Injected sclera (blood shot eyes)
Elevated heart rate
Elevated respiratory rate
Respiratory distress
Severe depression
Unable to rise or unable to arouse
Diarrhea
Straining to defecate
Colic
Grinding the teeth

This a disease syndrome which should not be handled in the field and needs to be referred to a hospital. These foals require intensive care and close monitoring. They may require oxygen therapy, assisted ventilation, intravenous nutrition, and constant nursing care. Broad-spectrum antibiotics, nonsteroidal antiinflammatories, intravenous fluids, drugs which egulate blood flow, are among the medications required to sustain life.


RUPTURED BLADDER

The most common disorder of the bladder of the newborn foal is rupture. Most common in colts, it may occur in fillies. The clinical signs are usually present within the first two days of life and include straining to urinate, dysuria, depression, and bilaterally symmetric distension of the abdomen.

Surgery is the treatment of choice and the success rate is high is performed within the first 5 days of life. Emergency surgery usually is not required. The greatest concern is the hyperkalemic (high serum potassium) state the foal is in. Hyperkalemia can cause profound cardiac disease which can result in death.

Always consult your veterinarian in matters regarding the health
of your horses!

Shenandoah Miniature Training and Foaling Center

Contact:
Brandy or Carp Carpenter
24757 State Highway 56
Whitesboro, Texas 76273
(903) 564-9447
Fax: (903)564-7629
Shenandoah


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