FRANK J. MILNE STATE-OF-THE-ART LECTURE


cifics and guidelines for administration can be found in Madigan.103,104


Other Therapies


Polymixin (6000 U/kg IV TID) has proven useful in improving attitude scores and blood glucose concen- trations and decreasing lactate and cytokine values in an endotoxemic model of foal sepsis.105 It should be noted that use in clinically compromised foals is still lacking.


Prognosis and Outcome


Prognosis for survival is guarded with blood culture positive foals; mortality may be 50% even with in- tensive care. If foals present collapsed and coma- tose, the prognosis is very poor. Complicating potential sequelae to septicemia include osteomyeli- tis, corneal lesions, pneumonia, patent urachus, ar- thritis, joint infections, and gastric ulcers. Short-term survival is negatively associated with


age at admission, septic arthritis, band neutrophil count, and serum creatinine concentration whereas factors positively associated with survival include diarrhea, rectal temperature, neutrophil count, and arterial blood pH.89 Reports of the effect of neona- tal sepsis on future athletic performance vary. Sanchez et al state that surviving Thoroughbred foals (n  102) did not differ from siblings with regard to percentage of starters, percentage of win- ners, or number of starts; although surviving foals had significantly fewer wins and total earnings.89 In contrast, however, a longitudinal study of 35 foals showing clinical symptoms indicating septicemia within their first 18 hours postpartum and 88 con- trol foals determined that a significantly higher pro- portion of septic foals (29%) compared to control foals (7%) were killed or died before 2 years of age (p  0.001).106 The majority of the remaining sep- tic foals were poor performers and some were used only for pleasure riding.106


Take Home Point: Preventing Septicemia


1. Keep the mare in the facility in which foaling will take place to allow production of antibod- ies to pathogens within this environ- ment. Clean foaling stalls twice daily and disinfect stalls between use. Wash the mare before foaling from the withers caudally.


2. Immediately following delivery, prevent the foal from contacting the mare until steps 3 and 4 are completed.


3. Wash the mare after foaling with large vol- umes of soap and water to remove bacteria around the perineum, udder, and rear quar- ters, which the foal may lick during udder seeking. Dry the mare.


4. Milk the mare’s cleaned mammary gland of 2 to 4 oz of colostrum (preferably greater than 1060 specific gravity) and bottle feed the foal, prior to the foal rising, upon obtaining a suck


reflex. Use colostrum from colostrum bank if necessary.


5. If the foal is weak, tube feed the foal within 1 hour of birth with 6 to 8 oz of colostrum or, if none available, use mare milk replacer or, if none available, use cow’s milk. In orphan foals, continue feeding from a bottle or pan until 10% of body weight is fed. Feed when the foal is hungry.


6. For any foal from an unobserved birth and for foalings in an unclean area without the above precautions, I recommend veterinarians pre- scribe and commence antibiotic therapy within 8 hours of birth and treat for 48 to 72 hours only. Longer treatment may produce antibiotic resistance and should be reserved for ill foals. The choice of antibiotic therapy will vary with the geographical area. If you have nothing to go on in your area, try using procaine penicillin 20,000 units/kg IM and gentamicin 6.6 mg/kg IM—both given once daily or ceftiofur (5 mg/kg IM). Post birth antibiotics have been a routine part of man- agement on stud farms in the United King- dom for the past 40 years, and the incidence of sepsis is much lower than the United States. For those of you concerned about aminoglycoside antibiotics in foals, monitor serum creatinine or urinalysis if you so desire. I find aminoglycosides safe in foals that are kept hydrated; that is most important. In a bright, alert foal receiving short-term antibi- otics, this should be no problem.


5. Management of the Umbilicus


Gumshoe Sleuthing Data on umbilical care and disinfection in domestic animals is scarce. I was invited by the AAEP to give a presentation on Management of the Newborn Foal in 1990. I wanted to use the literature to obtain evidence for various post birth procedures we routinely perform. Studies on the care of the um- bilicus were very limited with a paucity of evidence based medicine. Treatment of the umbilical stump is performed in an attempt to limit the number of microorganisms colonizing the area and prevent lo- cal and systemic infections which, in foals, can have severe consequences. In the 1990s, we recognized the need for a study describing the types of micro- organisms that colonize the equine neonatal umbil- ical cord in the immediate post-birth period and to evaluate the effect of common umbilical disinfec- tants on the microflora of the external umbilical stump 6 hours after initial treatment. We recruited 139 foals from two sites in northern California during the 1990 to 1991 foaling season.83 Both study sites used clean, dirt floored stalls bed- ded with straw for foaling. Inclusion criteria were normal events of labor and delivery, and no physical signs of infection or congenital abnormality at birth.


AAEP PROCEEDINGS  Vol. 60  2014 117


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