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EQUINE VETERINARY EDUCATION


Equine vet. Educ. (2018) 30 (2) 106-112 doi: 10.1111/eve.12584


Review Article


Management and treatment of the sick equine neonate in ambulatory practice


S. M. Austin Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA. Corresponding author email: smaustin@illinois.edu


Keywords: horse; neonatal; foal; treatment


Summary The ambulatory practitioner is usually the first to evaluate the equine neonate and must assess the foal and determine its health status. If one or more abnormalities are identified, the practitioner must initiate appropriate treatment and determine whether the foal can be managed successfully on the farm or referred to a specialty centre. This article describes the basic requirements that should be met and the limitations involved in treating compromised neonates on the farm. Treatments for common foal disorders are discussed.


Introduction


Clinical assessment of neonatal foals is a routine task of the ambulatory equine practitioner. If one or more abnormalities are detected during the initial examination, then the practitioner must decide if the foal should be treated on the farm or referred to a hospital for more intensive care. Factors involved in this decision include severity of the illness, value of the foal, resources of the owner, and availability of specialty services in the area. If the foal remains on the farm for treatment, the practitioner must evaluate the environment, determine the personnel needed to administer care, address the nutritional and fluid needs of the foal, collect appropriate laboratory samples, and then administer therapy to address the specific abnormalities that are present. Regardless of whether a foal is to remain on the farm or be referred, the examining practitioner needs to decide what immediate treatment is necessary.


General nursing care


Environment If referral of the foal is not necessary or not available, the practitioner must make recommendations regarding the proper treatment environment. Housing should be clean, dry, draught-free, warm, and provide a nonslippery footing with adequate padding. The newborn foal is wet, has a large surface to mass ratio, and limited energy reserves so it can become chilled at low environmental temperatures. Also, sick foals have impaired thermoregulation and do better if environmental temperatures are not cold (Ousey et al. 1992; Morresey 2014). Foals should be dried-off as soon as possible and supplemental heating should be provided. In unheated barns, space-heaters or heat lamps may improve the treatment environment. Care should be taken to avoid fire hazards because of the flammable nature of bedding and other environmental objects. The heat lamp should be at least five feet above the foal as the foal’s skin is thin and


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susceptible to thermal injury. Air blankets (Bair Hugger)1 provide an effective way to warm hypothermic foals safely, but care should be used to keep the warming unit away from flammable materials. Recumbent foals need clean bedding and good


insulation from the ground. Large bean bags are relatively inexpensive and can be used to create a foal bed. Pillows can be used to prop the foal into a sternal position which aids respiratory function. Recumbent foals need to be turned side-to-side at least every 2 h. Disposable incontinence pads can be used to collect urine and should be changed frequently. All wet skin should be dried and zinc oxide ointment may be used to protect vulnerable areas. Down foals are at increased risk for corneal ulcers and artificial tears may be applied every 6–12 h. Fluorescein staining of the cornea should be performed at least once daily. Many sick foals will require a constant attendant to


protect the foal and facilitate treatment. The lack of trained personnel is one of the greatest challenges to managing sick neonates in the field. Instructions to attendants should be in writing and cover specific parameters requiring further evaluation by the veterinarian. The veterinarian and owner should discuss the limitations of monitoring imposed by continuing care on the farm and agree upon the frequency of veterinary evaluation of the patient. Point-of-care devices can provide stall side information about lactate, serum amyloid A and glucose levels that aid treatment decisions, but haematology, blood gas analysis and biochemistry profiles will not be immediately available (Austin 2013). Ongoing laboratory evaluation will need to be performed frequently until the foal is stable, but treatment decisions must either occur without the benefit of immediate laboratory support or be delayed until laboratory work is available. Venous access is an essential component of on-the-farm


care. Teflon and polyurethane catheters are commonly used in veterinary practice. Teflon catheters tend to be more rigid and easier to insert but pose an increased risk of thrombophlebitis and sepsis compared with polyurethane catheters (Hunter 1989; Smith 1996). Polyurethane catheters are flexible and are recommended for use in foals. Over-the- needle catheters are less expensive and easier to insert, but over-the-wire catheters last longer, are easier to maintain, and have fewer complications than other types of catheters. Flow rate is inversely proportional to catheter length, so shorter catheters should be chosen if a rapid bolus of fluids is the treatment objective. For longer-term venous access, the longest catheter suited for the insertion site is recommended especially if medications are potentially irritating to the vein (Tan et al. 2003).

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