Neonatal Emergency Management in the Field

Rhonda Rathgeber, DVM, PhD (in anatomy and locomotion) of Hagyard-Davidson-McGee (HDM) veterinary firm in Lexington, Ky., stressed the need for early assessment of the newborn foal in looking for abnormal conditions. Her talk was given at the Reproduction Symposium hosted by HDM.

In order to recognize abnormal, she said observers needed to know what normal parameters are. “In my opinion, the biggest factor in the successful care of a neonate is careful observation and education of the owners, farm managers, and foaling personnel. In all neonatal emergencies, the sooner treatment is initiated, the better the outcome.” She recommended that all veterinarians give a list of potential neonatal emergencies and normal parameters of the newborn to those who might attend the birth. Her list included:
• Gestational age: 315-365 days;
• Time to sucking reflex: 20-30 minutes post-foaling;
• Time to standing: less than two hours;
• Time to nursing: 60-180 minutes;
• Ability to stand unassisted: less than three hours;
• Body temperature first four days: 99-102 degrees Fahrenheit;
• Heart rate for first five minutes: 60-80 beats per minute;
• Respiratory rate: 60-80 breaths per minute for first 15 minutes; then 20-40 breaths per minute;
• First urination: eight hours after birth;
• Meconium passage: within 12 hours.

Rathgeber pointed out that the history of the pregnancy can indicate potential foaling problems. Those might include fever in the mare, purulent vaginal discharge, colic surgery, excessive medication, premature lactation, and placentitis or placental separation as diagnosed via ultrasonography.

She noted that conditions during labor and presentation also are important to consider when evaluating a newborn. These include premature parturition, abnormally long gestation, prolonged labor, stained or discolored amniotic fluid, thickened or heavy placenta, dsytocia, and c-section surgery. “Make sure the veterinarian looks at the placenta,” stressed Rathgeber, noting that a normal placenta weighs about 10% of the foals’ birth weight.

The most common emergency in the newborn is asphyxia, or lack of oxygen. She noted that most cases require resuscitation and the concept of ABC is useful: A=Airway, B=Breathing, and C=Circulation. She explained how to give mouth-to-nose resuscitation to the foal which his not breathing.

“The first step is to clear the airway, remove membranes and dry placental fluids,” noted Rathgeber. “Meconium staining represents a special problem and it may require suctioning, if available in the field, to remove material from the nostrils, pharynx, and the trachea. Vigorous rubbing may provide tactile stimulation and initiate breathing. Mild chest compressions may also be useful. At this point if breathing has not spontaneously started, it is time to ventilate the foal. If there is no equipment readily available, mouth-to-nose ventilation can be used. The foal’s neck should be extended, the nostrils cleared, the down nostril occluded, and a breath delivered to the up nostril approximately 20-30 times per minute. The size of the breaths delivered should be sufficient to cause the foal’s chest to visibly expand.”

Rathgeber strongly recommended that anyone who has foaling mares should have a small tank of oxygen available for resuscitation efforts. She said it is extremely important to give a distressed foal 100% oxygen. If a farm does keep an oxygen tank, make sure it is checked and charged prior to foaling season. She said a humidifier can be put with the oxygen, but if a foal needs that type of care, she usually refers it to a clinic.

Rathgeber also uses acupuncture stimulation during ventilation of a foal. She described using a standard 16-18-gauge hypodermic needle on a specific acupuncture point on the horse’s nose, which has clinically been proven to stimulate respiration.

Circulation is the next critical step in the compromised foal. Chest compressions can be used at a rate of 100-120 compressions per minute. “It isn’t necessary to coordinate the chest compressions with breathing,” said Rathgeber. The possible complications include rib fractures and heart and lung contusions. As soon as possible, the veterinarian should insert a catheter for fluid therapy.

Important nursing care includes keeping the foal warm and as sternal (on its chest/belly) as possible. Rathgeber recommended using a down vest, blankets, warmed IV fluids, and wetted towels heated in the microwave and placed in plastic bags. If the foal is down, it should be propped sternally or turned every two to three hours. Make sure to keep the mare calm and comfortable, and keep the stall and working area clean.


About the Author

Kimberly S. Brown

Kimberly S. Brown was the Publisher/Editor of The Horse: Your Guide To Equine Health Care from June 2008 to March 2010, and she served in various positions at Blood-Horse Publications since 1980.

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