Foal care from the first few hours of life to one month can be critical in the overall health and welfare of the newborn foal. With experience caring for 300-500 Central Kentucky foals per year since 1985, Scott Pierce, DVM, MRCVS, of Rood and Riddle Equine Hospital, summarized his knowledge on "Foal Care From Birth to 30 Days" in his presentation at the 2003 American Association of Equine Practitioners' convention. He provided a basic review of the most common problems and how they are handled in his practice.

First Exam
"The immediate post-partum examination is very important," said Pierce. "Early detection of problems and prompt veterinary care are critical to the overall outcome of the compromised foal."

Farm personnel are usually the first to examine the foal, and they should be able to recognize abnormalities, he said. All farms should have an emergency kit, and foaling staff should have basic knowledge of pulmonary resuscitation of the newborn. "Many times, a brief administration of nasal oxygen will make a great difference in the immediate health of compromised foals," said Pierce.

Respiratory rate should be 60-70 breaths per minute, and the foal should begin breathing within 30 seconds of birth. Mucous membrane color should be pink one minute after delivery, and capillary refill time should be two seconds or less. Pierce also said the foal should respond to external stimuli, such as touch and noise, begin a suckle reflex within about five minutes. Heart rate can be evaluated by watching for the heartbeat through the chest wall. Normal heart rate for newborns is 60-120 beats per minute.

The umbilical cord should be allowed to break on its own (usually within five to six minutes after birth), then it should be immediately dipped in 0.5% chlorhexidine or undiluted povidone solution. Handlers should wear gloves to prevent contamination of the umbilicus, said Pierce.

The foal will usually stand within one hour of birth and nurse within two hours. If a foal does not nurse within five hours, a veterinarian should be called. The veterinarian will give the foal colostrum (a mare's first milk), which contains needed antibodies so that the foal can fight infection. In addition, the mare's udder should be examined. The mare's colostrum can be measured with a Colostrometer. If the colostrum measures a specific gravity under 10.6, then donor colostrum should be given. Some mares will object to the foal's nursing. In this instance, they can be sedated with acepromazine.

In addition, a foal should pass his meconium (first feces) within 24 hours after birth. To help this along, he can be given an enema. Pierce recommended either a commercially available human sodium phosphate product or warm soapy water.
Veterinary Exam
The veterinarian will usually come the morning after delivery (as most foals are born at night) or when foals are only a few hours old. He or she will examine the foal's general condition, strength, mental status, and ability to nurse, along with conformation. The veterinarian will listen to the heart and lungs for any abnormalities, palpate for fractured ribs and a cleft palate, examine the umbilicus, and look in the eyes.

When a foal is past 12 hours of age, or it is six to eight hours after the first nursing, a complete blood sample can be drawn to measure immunoglobulin (IgG, a type of antibody) levels. Pierce likes to see IgG levels above 400 mg/dl. Foals at risk for disease should have an IgG level above 800 mg/dl. If IgG levels are lacking, fresh frozen plasma can be given intravenously. Pierce said that he gives flunixin meglumine (Banamine) along with the plasma to prevent adverse reactions.

CBC's can also be performed to determine the WBC counts.  Occassionally these bloods have to be drawn more than once.Sometimes WBC counts are not normal until Day 4, but if any of the measurements are abnormal, farm personnel should watch the foal more closely for signs of depression, lameness, diarrhea, or lack of nursing. In a normal foal with an abnormal WBC count, the temperature should be taken twice daily.

In Pierce's practice, a mare and foal are usually turned out by themselves for at most an hour in the first day, with the time increasing each day. After 10-12 days, they join other mares and foals in a large field.

Common Abnormalities
Angular Limb Deformities--Pierce said angular limb problems are common. Foals are usually graded on a scale of zero to three (with zero being straight) to help evaluate severity and improvement of the problem. "Most foals will improve without treatment within the first 30 days of life," he said. "Therefore, one should let the foal improve on its own and initiate specific therapy only when the foal has stopped improving, the rate of improvement has slowed, or a drastic change in the conformation has occurred." Each type of deformity is treated differently, but treatments can involve periosteal transection, limited turnout, special trimming and/or shoes, and monitoring through radiographs for changes and/or a deterioration in the foal's conformation.

Congenital Papillomas (Warts)--These can be found on various parts of the body; however, the head and legs are the most common locations. Pierce said that warts are usually not a problem unless they hemorrhage from trauma. Hemorrhaging can usually be easily stopped. He said that warts will usually go away on their own.

Delayed Ossification of Cuboidal Bones--Crushing of the carpal (knee) or tarsal (hock) bones can be found in premature foals or term foals with conformational problems. "Foals with severe conformational defects or delayed ossification of their cuboidal bones are stall confined, and radiographs are taken weekly until cuboidal bone mineralization has occurred," Pierce said. "Splinting might be required in the occasional severe case, especially with concurrent soft tissue laxity; however, it should be avoided if possible."

Diarrhea--This problem can be serious with many unfavorable results. Diarrhea in the foal can be due to a non-life-threatening situation, such as milk overload, a change in the gastrointestinal flora, or be related to foal heat. However, it could be related to such serious diseases as rotavirus or bacterial infections. Rotavirus can affect foals at any age, is highly contagious, and is very hard to control, with bleach being the disinfectant of choice. Treatment involves supportive care and isolation. A vaccine is available pre-foaling for broodmares to reduce the severity of the disease in older foals, although it has not been known to help young foals, said Pierce.

Bacterial diarrheas are typically caused by Clostridium and Salmonella species, are usually profuse and watery, and are usually seen with depression and toxemia. Fecal cultures, virus isolation, and Rotazyme tests are used for diagnosis, and depending on the specific diagnosis, a variety of treatments can be used. Fluid therapy is common and can help foals recover faster. "Many foals can be treated on the farm if the personnel are qualified," Pierce said. "A major complicating factor is abdominal pain. Most painful foals are referred to the hospital."

Entropion--This occurs when the eyelid turns inward against the eyeball. This is the most common eye problem, and it can be treated with an injection of procaine penicillin in the affected eyelid. Restraint of the foal is very important during this procedure to prevent needle damage due to movement.

Failure of Passive Transfer--Foals which don't receive enough antibodies through the colostrum suffer from failure of passive transfer. Pierce recommends that all foals which have not reached an IgG level of 400 mg/dl receive one or more liter of plasma intravenously. Blood is then drawn to see if levels are high enough. Foals at risk for disease should have immunoglobulin (IgG) level above 800 mg/dl. Those below 200 mg/dl are considered an emergency. If the quality or amount of the colostrum is in question, then the foal should be given stored, tested colostrum within 12 hours of birth.

"Recently, some insurance companies have developed their own policies and requirements for IgG concentrations before insuring foals for mortality," Pierce said. "These different policies can be confusing at times and can be an added expense to the client."

Flexor and Extensor Abnormalities--The most common flexural weaknesses--back at the knees and weak pasterns--will usually correct themselves in the first few weeks. Turnout is restricted. Trimming and special shoes can be used for support. "A small bandage with extra padding behind the heel bulbs can serve as adequate protection until the foal strengthens or until shoes can be applied," said Pierce. "Without protection, heel bulb and pastern lacerations are common in these foals. Usually, a round pen or small temporary pen works well for initial turnout."

Fractured Ribs--Fractured ribs can be deadly if the rib penetrates the lungs or heart. "No foal should be turned out into a paddock until its ribs have been palpated," he said. "Fractured ribs are most common after dystocia or in very large foals. If the foal has fractured ribs, it should be restricted to a stall for approximately three weeks. Usually, this length of time will allow for stabilization of the fracture site, and an adequate fibrous callus over the fracture will form." Pierce said that with mild fractures, signs might include colic after exercise or an increased heart or respiratory rate. Ultrasound can confirm a fracture if it is not readily palpated.

Head Tilt--This is seen in many normal foals and usually does not last longer than seven days. It is possibly caused by birth asphyxia or maturation of the nervous system, said Pierce. He recommended that a careful examination and a CBC be performed in case of underlying disease.

Heart Murmurs--Most heart murmurs can be considered normal and will go away within two weeks, but if one does persist, a cardiac ultrasound examination is suggested. Normal heart murmurs can be found in very excitable foals, but will go away if the foal is lightly tranquilized. However, abnormal murmurs will not diminish with tranquilization.

Hypoxic Ischemic Encephalopathy (dummy foals)--This syndrome is also known as neonatal maladjustment syndrome and can be seen in foals which might have been affected by premature placental separation (red bag delivery), dystocia, or non-elective Caesarean sections. Signs such as delayed nursing or standing, wandering, and/or seizures can appear as early as 48 hours after birth or as late as five days. These foals are usually referred to a veterinary hospital.

Leg Edema--Some foals might develop swelling in the lower legs, with no fever or illness. Management with turnout in a small paddock and banamine for one day can reduce swelling, with a few requiring bandaging, said Pierce.

Meconium Impaction--If the foal has a problem passing his meconium, he might experience abdominal pain. Another enema of warm, soapy water can be given along with Banamine and mineral oil given through a nasogastric tube. If the foal passed his meconium before birth, then the amnionic fluid will be fecal tinged and the amniotic fluid that entered the foal's lungs might have been contaminated. This could lead to meconium pneumonia.

Neonatal Isoerythrolysis (NI)--"Neonatal isoerythrolysis occurs when the foal inherits different blood antigens (types) from the stallion and the mare," Pierce explained. "As a result, the mare has produced antibodies to these antigens, which are concentrated in her colostrum. The foal nurses the colostrum, and, depending on the concentration and type of antibodies, the foal develops hemolytic anemia (anemia resulting from decreased red cell survival time) within 24-96 hours of age. Affected foals become icteric (have yellow membranes), depressed, and anemic." 

Treatment involves supportive care and blood transfusions; however, prevention through the use of a red blood cell (RBC) antibody screen within 30 days of birth can help determine if a foal is at risk. Pierce recommended that if a mare had not foaled within 30 days of the screening, that it be repeated. He said that he will muzzle a positive foal for 15 hours after birth to prevent nursing. The foal will receive compatible colostrum through bottle feeding, and the mare is milked and her colostrum discarded. Some veterinarians prefer to muzzle the foal for 24 hours.

Omphalophlebitis--Inflammation of the umbilical veins and umbilical remnant infections are now less common. Inappropriate handling of the umbilicus during delivery or an unsanitary environment could cause this problem. Pierce said that less than 1% of foals are affected. As with patent urachus (more on this later), weak or recumbent foals are more at risk due to increased exposure to bedding, dust, and/or fecal matter. Infections are usually found three to four weeks after birth when the dried umbilical remnant does not fall off. Some foals develop fevers, an elevated white blood cell count, pus-like drainage, and/or an abscess. Ultrasound can help determine the severity, structures involved, and extent of the infection, allowing the veterinarian to make a judgment on the type and length of treatment, he said. Treatment is usually with antibiotics, although occasionally an abscess might be lanced and cultured. Surgery is rarely needed. A follow-up ultrasound exam and CBC counts can be done to determine when treatment should be ended.

Patent Urachus--"The urachus is the in-utero connection between the fetus� urinary bladder and allantoic cavity," he explained. "In normal foals, this structure closes soon after delivery, and it eventually completely regresses to a group of ligaments. If the urachus does not close, urine will exit the umbilical area." Pierce said that a urine-soaked umbilicus can sometimes be seen, especially in weak foals, those which struggle to rise, and foals which strain to defecate due to meconium retention. One concern is that bacteria can gain entry through the foal's abdomen. Therefore, broad-spectrum antibiotics are used, and after two to three days, closure is attempted with the use of silver nitrate sticks over three to four days. In some cases, surgery is required to correct the problem.

Premature Foals--Pierce said that due to differences in fetal maturation, a wide range of gestational lengths is possible, with a normal gestational length between 322-345 days. Some mares will foal as early as 310 days and have a normal foal. However, foals born under 310 days might need intensive therapy to survive. "One must consider the advisability of these attempts, because many foals have developmental skeletal issues as they grow on their relatively immature skeletal structure," Pierce commented. "The cost of salvaging these very immature foals is considerable."

Scleral (Eye) Hemorrhage--Although no problems have been associated with bleeding in the sclera, Pierce commented that it might be noticed. It can be caused by trauma at birth.

Septic Arthritis (Joint Ill or Navel Ill)--When circulating bacteria are shed into the blood, they can lodge and grow in the epiphyseal or metaphyseal growth complex, and possibly extend into the joint cavity. Synovial colonization is less common. Bacteria can then cause septic arthritis, also known as joint or navel ill. Pierce believes that not only can infection begin in the umbilicus, but that bacteria from the intestine and respiratory tract could be more common sources.

"Any time a foal presents with lameness and fever, septic arthritis is the first problem to rule out," he said. "Waiting just one day can many times make a serious difference in the eventual outcome. It cannot be stressed enough that a lame foal with or without a fever should be looked at very closely for the presence of septic arthritis. The longer one waits to lavage (wash) the joint, the more the cartilage is damaged. Additionally, the infection seems to become more deeply seated in the bone, making the treatment more extensive and costly with a poorer prognosis."

In addition to joint lavage, the foal is given antibiotics targeted to the specific bacteria; the antibiotic choice has been determined through a culture. "Foals with a clinically identifiable septic joint that is not obvious along with lameness and fever are started on systemic antibiotics and monitored very closely," said Pierce.

Radiographs can also determine if metaphyseal osteomyelitis (bone infection) is causing pain and lameness.

Septicemia--Septicemia, or systemic disease, can appear within the first few hours of life, said Pierce. Signs include inability to stand and nurse, discolored mucous membranes with poor perfusion, and septic shock with cardiovascular collapse. Immediate treatment is necessary. Despite treatment, foals can develop septic arthritis or osteomyelitis. Affected foals are referred to a hospital for treatment.

Many cases of septicemia are caused by bacterial placentitis. Those born with equine herpesvirus usually die. Foals born with leptospirosis might be small, but they are usually mature.

Umbilical Bleeding--If hemorrhaging occurs, a commercially available clamp can be used to stop the bleeding. These foals should be watched for signs of infection over the next two to three weeks. If an infection develops, antibiotics can be given.

Umbilical Hernia--These can be palpated upon first exam; however, they become more obvious after several weeks. Hernias are usually treated closer to weaning.

�Windswept� Foals--A foal might be termed a windswept foal if he has a conformational abnormality that results in both limbs being slanted in one direction. This could be caused by improper fetal position during the last few weeks before birth. A veterinarian will need to evaluate the curvature of the long bones and look for any spinal deformities. Affected foals are confined to stall rest until improvement warrants a change to a round pen or paddock. Surgery, such as a periosteal transection or transphyseal bridging, might be needed; however, most foals will correct themselves.

More on Flexural Deformities
Pierce said the most common mistake in treating flexural deformities is not being aggressive enough if the foal is not responding to treatment. If bandaging, tetracycline, and turnout are not enough, then splinting might be necessary; this should produce response within three days.

Over at the knees conformation is very common, and most foals improve with exercise. "I have not had much success with surgery, casting, or tetracycline in severe carpal flexural deformities," said Pierce. "Even some of the more severe cases will improve in a couple months with paddock exercise."

Owners can let the foal exercise in a small paddock with his dam; however, when the foal becomes tired--which is evidenced by trembling legs--the mare and foal should be put in a stall. This can occur after 30 minutes. However, the mare and foal can be turned out up to four times daily.

"Patience is the most successful, non-stressful method of treating flexural deformity of the carpus in the foal," he noted.

Pierce concluded his presentation saying that at the end of the foal's first month, most neonatal diseases become less frequent. He stressed the importance of the initial exam, along with follow-up exams if needed.

About the Author

Sarah Evers Conrad

Sarah Evers Conrad has a bachelor’s of arts in journalism and equine science from Western Kentucky University. As a lifelong horse lover and equestrian, Conrad started her career at The Horse: Your Guide to Equine Health Care magazine. She has also worked for the United States Equestrian Federation as the managing editor of Equestrian magazine and director of e-communications and served as content manager/travel writer for a Caribbean travel agency. When she isn’t freelancing, Conrad spends her free time enjoying her family, reading, practicing photography, traveling, crocheting, and being around animals in her Lexington, Kentucky, home.

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