Dr. Kirsty Gallacher BVMS DipACT
Dr. Kirsty Gallacher BVMS DipACT
§ DELIVERY OF A LIVE FOAL – Breathe an initial sigh of relief!!!§ A foal can be regarded as “low risk”
§ Gestation normal duration – average 336-342 (320-360d)
§ Normal birth § Active labour (stage 2) lasts <20 mins§ No manipulation of foal is necessary
§ Normal postpartum events:§ Foal stands within 1-2 hours of delivery§ Foal nurses within 2-3 hours of delivery
§ Placenta visually normal and correct weight
1st stage labour(mins)
2nd stage ACTIVE labour (mins)
3rd stage labour –PASS PLACENTA (hrs)
<240 10-20 0.5 -3
>240 20-30 3-6
>240 >30 >6
Ifthedeliveryislongstanding:Foaldevelopsasphyxia->compromised->death
Sitting in sternal (mins)
Suck reflex (mins)
Time to stand(hrs)
Time to suck (hrs)
5 5-10 0-1 0-2
5-10 10-15 1-2 3-4
>10 >15 >2 >4
1-2-3ruleStand<1h– Nurse<2h- Passmeconium<3h
• Firstbreathswithin30seconds ofchestbeingdelivered.Initiallyfoalmayappeartogaspbutthenbreathingshouldbecomefastanddeep.
• Headshakingandsternalrecumbency with“rightingreflex”within2to3minutes.
• Strongblinkingreflexes.Mayshowvocalisation.Theheadbobsupanddownmarkedly.
• Foalstartstostruggleoftenbreakingtheumbilicalcord(atalengthof3to5cms).Averagetime6to8minutes
• Suckingreflexwithlipsandmouthwithin30minutes• Firstattemptstostandwithin30minutes• Standingsuccessfullywithin60minutes (ifnotby120minutes–call)
NORMAL FOAL
• Udderseeking• Firsteffectivesucklingwithin120min (ifnotby240min– callVET)
• Frequencyofnursing
• 7times/hr duringweek1• 3times/hr atweek4• 1time/hr at6months
NORMAL FOAL
• Afterapprox.60min newbornfoalwillliedownagain,especiallyafterfeeding
• Foalsspend33%oftheirtimelyingdown
• Ifwokenthenewbornfoalshouldbealert
• Anormalfoalwillgetupandnurseifwoken
Normal foal behaviour
• Mostfoalsnursetwiceby2½hoursofage• Sleepby1½-4hoursofage(mean3hours)• First“play”by2hoursofage• Gallopingobservedby6hoursofage• Foalstypicallyspend94-99%oftheirtimeinthefirst2weekswithin5metres oftheirdam
WHAT TO EXPECT FROM THE NEWBORN FOAL
• Thenewbornfoalispoorlycoordinated• Thejointsandligamentsmaybenotablyslack• Insomecasestheflexortendonsmaybetight• Mostoftheseproblemsself-rectifyinthefirstfewdays
WHAT TO EXPECT FROM THE NEWBORN FOAL
• Iftheproblemisnotimprovingafterseveraldaysorappearstobegettingworse– call!
• Beawareofthesevereangularlimbdeformitiesassociatedwiththeprematurefoal
§Mucous membrane colour should be salmon pink
§Capillary Refill Time < 2 seconds.
§ PARAMETERS CHANGE QUICKLY OVER TIME!!
§ HR = 40-80 bpm immediately after birth§ Will rise to 130-150 BPM within minutes of birth§ Then gradually decrease to 60-120 over the 1st week of life§ Can be normal to hear murmurs in 1st week of life (closure of
ductus arteriosus)
§ RR > 60 BPM immediately after birth§ Falls to 20-40 within 1-2 hours
§ Temperature – 37.1 – 38.9 C
§ Mucous membranes = pale pink and moist CRT<2 secs
§ Mouth – mucous membranes, palate, bite size
§ Eyes – eyelash position
§ Heart rate, murmurs, arrhythmias
§ RR, Listen to chest & palpate ribs
§ Umbilicus – dry/small, hernia, patent urachus
§ Testicles – palpate/ scrotal hernia
§ Temperature
§ Palpate joints
§ Look at legs, tendons – contracted/relaxed, ALD
§ Nursing behaviour/mares udder
§ Normal foals - spontaneous breathing and movement within secs of birth§ Great – leave to bond with mare§ If not, then rapid assessment and immediate intervention is necessary§ Place in sternal recumbency§ Remove any membranes § Bulb syringe to clear nasal passages§ Palpate/auscultate heart rate
§ Normal foals >60BPM (80-100BPM)§ <60BPM concerning
§ Vigorous rubbing & drying of the head neck & body – stimulate breathing and correct mild bradycardia
§ Stimulate the inner ears or nasal passages
§ Foal failure to transition from Fetal -> neonatal physiology
§ Foal born alive (i.e., with Heart Beat & pulse) but fails to spontaneously breathe
§ Without intervention -> hypoxia induced bradycardia> asystole & death
§ Decisions & interventions need to be made within the first 2minutes –ideally 30 secs of life
§ Foals not breathing or with HR <50 should receive ventilation
§ Ideal ventilation is with intubation
§ Next best is ventilation via a mask
§ Next best is mouth to nose
§ 10 breaths/minute – they should be quick – enough to expand the chest
§ The foal should be reassessed 30-60 secs after starting ventilation
§ Worsening bradycardia or HR<40 should initiate thoracic compressions
§ Palpate for rib fractures before starting compressions -fracture side down
§ Compressions rate = 100-120 per minute
§ If foal has cardiac arrest > thoracic compressions straight away
§ If more than 1 person then 1 can assist cardiac support and the other ventilate§ 100-120 compressions/min & 10 breaths
§ If on your own 30 compressions followed by 2 quick breaths§ Ratio 30:2 then repeat
§ Mouth to nose occlude lower nostril & oesophagus
§ Reassess after 2 minutes (take no more than 10 secs to assess)
§When spontaneous breathing >16 breaths per minute
§Heart rate >60
§ If no response after 15 minutes – stop (IF NO HEART BEAT)
Maternal risk factors
§ Difficult birth (dystocia)§ Red bag delivery (premature
placental separation)§ Premature delivery <320days§ Infection of placenta (placentitis)
§ Mare may “bag up” early, run milk, have vaginal discharge
§ Previous history of birthing/foaling problems
Foal risk factors
§ Twins§ Premature/dysmature§ Death of dam§ Meconium staining§ Foals that don’t rise and nurse by
3 hours§ Failure of passive transfer
§ Premature <320 days
§ Dysmature may have normal gestation length but signs & behaviour consistent with prematurity.
§ Unreadiness for birth§ Small size for breed – low birth weight§ Weakness, slow to stand, poor suckle reflex, laxity of flexor tendons§ Poor maternal recognition & environmental awareness§ Incomplete ossification of tarsal/carpal joints§ Fine silky hair coat, curled ears§ Synechium – “slipper hooves”
§ Muscle weakness (delayed nursing)
§ Weak suckle
§ Poor thermoregulation & glucose dysregulation
§ GI & renal immaturity
§ Entropion
§ Poor glycogen stores
§ Neonate should be gaining 0.5-1 kg per day
§ Drink ~20% of their BW on milk/day
§ Colostrum intake within 6 h of age is essential
§ Examine ability to swallow § Suckling for a long time doesn’t mean swallowing
§ Presence of milk on nostrils:
§ Pharyngeal dysfunction
§ Cleft palate
§ Other causes of dysphagia
§ Foals are born fully functional but have a naive immune system – No immediate protection
§ Colostrum provides that immediate protection § Failure of passive transfer (FPT) of immunoglobulins (Ig) is a huge
risk factor for neonatal disease § FPT due to
– Premature lactation– Failure to nurse– Poor quality colostrum
§ Evaluation colostrum quality: § Visual inspection § Colostrometer: difficult, not very accurate
– measures specific gravity– s.g. of >1.060 corresponds to IgG of >3000 mg/dl
§ Ideally check foals blood between 12-24 hours via blood test§ >800mg/dl is a pass§ >400 <800 – partial failure§ <400 – failure of passive transfer
§ By 18-20 hours the ability of the intestine to absorb ingested colostrum is almost zero
§ 12-18 hours – oral colostrum or plasma
§ >24 hours - Corrective measure – IV plasma
§ Urinate by 8 hours – full flow rather than dribbling
§ Umbilicus palpate – gloved hand§ Enlargement, heat, swelling, discharge –
ultrasound exam required§ Urachus may remain patent for first 1-2 days –
check for sepsis/infection
§ WHAT IS MECONIUM?First faecal material produced by a newborn foal§ Made up of intestinal secretrions, cellular debris, amniotic fluid
§ Clinical signs:
§ Abdominal distention and colic:
• Swishing tail, depressed, dorsal recumbency, straining
§ Digital rectal exam, ultrasound, radiographs
§ Enema
§ Warm soapy water
§ Fleet (phosphorus) enema
§ N-acetylcysteine
§ Pain control (NSAIDs)
§ Surgery, if not responsive to therapy
§ Examine oral cavity – cleft palate, bite defects
§ Observe nursing behaviour and swallowing
§ Milk at nostrils could be cleft palate or pharyngeal paralysis
§ Meconium staining
§ Passage of meconium – quantity & colour
§ Check anus – atresia ani
§ Foals are notably intolerant of abdominal pain & will demonstrate signs of severe colic
§ Hypoxic-Ischaemic Encephalopathy, Perinatal Asphyxia, or “Dummy foal”
§ Placentitis, prematurity or postmaturity, “red bag”, and dystocia
§ Some foals look normal after birth
§ Variable signs: from hyperresponsiveness to unresponsiveness:
• Poor suckle reflex, no interest on mare, dull, wandering, facial spasms, lip curling, ataxia, semi-coma or coma etc.
• Seizure-like activity can be present
§ Diagnosis is by clinical signs and elimination of other diseases (sepsis, etc.)
§ Prognosis depends on the amount of cellular damage
§ Recovery is possible with supportive care
§Foal inherits a blood type different than the mare
§1st foal usually doesn’t display any signs
§2nd foal drinks colostrum that contains antibodies against its own blood type
§ Foal consumes colostrum
§ Ab vs. foal’s RBC on surface of foal’s RBC
§ Qa & Aa blood types at risk
Signs 6-72 h after birth:
§ Dull and lethargic§ Pale yellow mucous membranes§ Tachycardia§ Cardiac murmur§ Dark yellow urine
Stallion Aa+ Mare Aa -X
Y
Y
YYY
Y
Y
Y
Y
Foal
Mare CirculationPlacenta
Anti-Aa antibody
YY
Y
Y
YY
YY
Mare circulation
Colostrum
Y
Foal Intestine
Foal Circulation
Y
Y
Y
Y
Y
Y
Y
§Screen mare for anti-RBC antigens in the last 2-3 weeks of pregnancy
§Keep foal from nursing colostrum, provide another source of antibodies such as plasma
§ Different signs than adults
§ Need prompt assessment
§ Painful foal won’t nurse
§ Will die if not supported
§ Non-infectious§ Osmotic diarrhoea & lactose intolerance
§ Microflora changes (~1 week of age)§“foal heat”
§ Faeces for culture
§ Antimicrobials in some cases
§ Supportive & nutritional care
§ Fluid therapy is often required
§ Electrolyte supplementation is important