EQUINE VETERINARY EDUCATION / AE / FEBRUARY 2018


111


do not respond to an initial enema, may require additional therapy including acetylcysteine enemas, fluid therapy and


laxatives by nasogastric tube. Pain can be managed with flunixin meglumine (0.25–0.5 mg/kg bwt i.v. q. 12 h), hyoscine N-butylbromide (0.14 mg/kg bwt, i.v.) or a combination of diazepam (0.05–0.2 mg/kg bwt i.v.) and butorphanol (0.01–0.04 mg/kg bwt i.v.). Mineral oil (100–200 ml) may be given by nasogastric tube for its lubricating effect. Acetylcysteine enemas have been used by the author


with success in resistant impactions. A 30 French Foley catheter is inserted 2.5–5 cm into the rectum, and the bulb is slowly inflated. Two hundred millilitres of 4% acetylcysteine solution are infused by gravity flow and retained by clamping the catheter for 20 min. The acetylcysteine may be repeated in 12 h if the impaction is not resolved. The University of California reported a 93% success rate with medical management of meconium impactions with 40% requiring more than one enema (Pusterla et al. 2004).


Musculoskeletal problems Angular limb abnormalities are frequent but most will spontaneously improve over the first 30 days. A surgical consultation should be sought for fetlock deformities that persist for >10–14 days or carpal/tarsal abnormalities that are not correcting or getting worse over the first 60 days. Radiographs should be taken of all premature foals to evaluate the degree of ossification of cuboidal bones in the carpus and tarsus. Foals with incomplete ossification should be stall confined until mineralisation has been completed. Flexure laxity may occasionally be seen, but rarely causes


a long-term problem. Initially, exercise is restricted. If the laxity is not improving after a few days, glue-on shoes with heel extensions may be required. A light bandage can be applied to protect the heels, but heavy bandages should be avoided as they will increase tendon laxity. Contracted tendons are a frequent occurrence and can


occur at the carpus, fetlock, pastern, distal interphalangeal joint and tarsus. If the foal is able to stand and nurse, then therapy may not be necessary. If limb contracture is not improving then a combination of limb bandaging, analgesia (flunixin meglumine, 0.5 mg/kg bwt i.v. q. 12 h), and oxytetracycline (2 g/50 kg foal, i.v.) may be used to facilitate relaxation. Oxytetracycline may be repeated every 24–48 h until desired tendon relaxation is observed (Trumble 2005) (Table 3). This drug may cause renal damage if used in the face of dehydration, so caution must be exercised when treating foals that require assistance to stand and may not be nursing effectively. More severe cases of limb contracture may require heavy bandages with polyvinyl chloride splints. With a little time and perseverance, most mild to moderate contracture will resolve satisfactorily.


Conclusions


As the first on the scene, the ambulatory veterinarian must not only assess the neonate, but must determine prognosis and treatment strategies for any abnormalities discovered during the examination. Many minor problems can easily be treated on the farm, but care for more severely sick foals may be compromised by the level of care that can be offered under the circumstances. The client must be fully informed as to treatment options and limitations of on-the- farm care vs. referral to a specialty hospital. If the foal is to


be treated on the farm, a discussion about personnel needs for successful management and treatment of a sick neonate is essential, as well as a candid discussion about the costs of multiple farm trips to re-evaluate the patient. Instructions for foal care in the absence of the veterinarian should be concise, clear and in writing.


Author’s declaration of interests No conflicts of interest have been declared.


Ethical animal research Ethical review not applicable for this review article.


Source of funding None.


Manufacturers' addresses


13-M, St Paul, Minnesota, USA. 2Mila International, Inc., Erlanger, Kentucky, USA.


References Austin, S.M. (2013) Assessment of the equine neonate in ambulatory practice. Equine Vet. Educ. 25, 585-589.


Axon, J.E. and Wilkins, P.A. (2015) The neonate. In: Equine Emergency and Critical Care Medicine, Eds: L. Southwood, P. Wilkins, CRC Press, Boca Raton. pp 797-808.


Brewer, B.D. (1990) Neonatal infection. In: Equine Clinical Neonatology, Eds: A. Koterba, W. Drummond and P. Kosch, Lea and Febiger, Philadelphia. pp 310.


Brewer, B.D. and Koterba, A.M. (1988) Development of a scoring system for the early diagnosis of equine neonatal sepsis. Equine Vet. J. 20, 18-22.


Buechner-Maxwell, V. (2012) Practical approach to nutritional support of the dysphagic foal. Proc. Am. Ass. Equine Practnrs. 58, 412-424.


Corley, K.T.T. and Furr, M.O. (2003) Evaluation of a score designed to predict sepsis in foals. J. Vet. Emerg. Crit. Care 13, 149-155.


Fielding, C.L. and Magdesian, K.G. (2015) Sepsis and septic shock in the equine neonate. Vet. Clin. N. Am.: Equine Pract. 31, 483-496.


Gold, J.R. (2017) Perinatal asphyxia syndrome. Equine Vet. Educ. 29, 158-164.


Hunter, A.C. (1989) Practical intravenous fluid therapy. Aust. Vet. Pract. 19, 223-226.


Jacobs, S.E., Berg, M., Hunt, R., Tarnow-Mordi, W.O., Inder, T.E. and Davis, P.G. (2013) Cooling of Newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst. Rev. 1, CD003311. doi: 10.1002/14651858.CD003311.pub3


Klein, C.J., Stanek, G.S. and Wiles, C.E. III (1998) Overfeeding macronutrients to critically ill adults: metabolic complications. J. Am. Diet. Assoc. 98, 795-806.


Lester, G.D., House, J.K. and Vaala, W.E. (2009) Initial management and physical examination of the neonate. In: Large Animal Internal Medicine, 4th edn., Ed: B.P. Smith, Mosby, St Louis. pp 262-280.


Magdesian, K.G. (2003) Neonatal pharmacology and therapeutics. In: Current Therapy in Equine Medicine, 5th edn., Ed: Robinson, N.E., W.B. Saunders, St Louis. pp 1-5.


Morresey, P.R. (2014) Assessing the weak foal. Proceedings of the American Association of Equine Practitioners Focus on the First Year of Life, pp 10-15


Ousey, J.C., McArthur, A.J., Murgatroyd, P.R., Stewart, J.H. and Rossdale, P.D. (1992) Thermoregulation and total body insulation in the neonatal foal. J. Thermal Biol. 17, 1-10.


© 2016 EVJ Ltd


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76