The Newborn Foal

Many problems can occur during the first days of a newborn foal - problems that are often life threatening. In this article we will deal with the two most important: Oxygen deficiency and infection.

To find out, if the foal is healthy and o.k. or if there are conditions of sickness or management problems is therefore of greatest importance. This is not only a task of the vet but also of the owner or caretaker of the foal.

Directly after delivery: The healthy foal will lie in sternal recumbancy without any help! If not it is sick or has suffered asphyxia, that is a deficiency of oxygen during parturition!

Often it will show hunger already during the resting period after delivery: It will suck its tongue and search for the milk by moving its head.

It will soon try to rise and walk. It will only sleep after beeing exhausted by its efforts to do so. And it will try again after only a little rest. A normal foal usually sleeps down, either in sternal recumbancy or lying flat. Some newborns just sleep standing because lying down and rising may be difficult. Then bring them down to sleep on the ground. (Later in life a foal that is sleeping standing may be a sign of sickness!)

If some parts of this normal behavior is missing or different, something is wrong and veterinary help is vital. Never forget: Do not waste time with sick foals!

The most important sign for a sick newborn foal is DEPRESSION:

The condition of the newborn foal can be interpreted in four categories:

NORMAL  -   MODERATE DEPRESSED   -   SEVERE DEPRESSED   -  NEARLY DEAD

This interpretation is done after examination of the foal.

Clinical examination of the newborn foal:

Just by observing You can check behavior and count respiratory rate:

Behavior:

Immediatelly after delivery: sternal recumbancy, later attemps to stand and seeking the teet and drinking.

Normal healthy foals are bright and alert and should remain responsive to all external stimuli.

Most foals with neurological disorders have variable degrees of depression but this is also a characteristic of many non-neurological diseases such as sepsis.

Premature or dysmature foals may be less bright and less aware than normal full term foals.

Respiratory rate:

Immediatelly after birth the rate is normally more than 60 per minute but this falls after one to two hours to 40 - 20 per minute. A decreased or an irregular respiratory rate is a sign of depression.

The patency of the airway must be assessed in any foal showing respiratory difficulty, i.e. increased and heavy, noisy breathing, flared nostrils!  Immediatelly after birth there may be mucous accumulation in the airway as a result of aspiration of uterine fluid. First aid: Move with Your flat hand over the nose in the direction of the nostrils. Then hang the foal on the hind legs, so that the head and neck are vertical: fluids can flow down with gravity (see photo).

Rapid respiration can also be the result of many systemic conditions: blood loss, sepsis, fever, pain, shock etc. or a result of congenital disorders of the airway.

Heart Rate/cardiovascular system:

Heart rate (palpate through chest wall) is 60-80 beats per minute immediatelly after birth, after 15 minutes it increases to 120-160 (and even higher during attempts to stand) and after 12 hours it is down to 80-120 beats per minute. During the first week it is between 60-70, but rises with exercise or excitement of the foal.

The mucous membranes should also be checked for color (pink: normal / pale and blue: cyanosis, lack of oxygen / yellow: icteric).

We can distinguish between two major groups of foal sickness:

INFECTIOUS DESEASES     -     NON INFECTIOUS DESEASES

The sick neonate is always at high risk of getting infected even when the first condition is non infectious, so in my opinion antibiotics are always necessary.

Infectious diseases are called SEPTICEMIA or NEONATAL SEPSIS and are caused by bacteria or virus:

Bacterial:    E.coli, Actinobacillus equi, Streptococcus equi, Staphylococcus aureus, Klepsiella sp., Salmonella and others

Viral: Equine Herpes Virus (EHV)

The foal is infected during late pregnancy (EHV or also some bacterial infections) or parturition. The foal is born week in the first case, and it becomes week in the second. Don´t forget that in neonatals infections can break out very fast, even within hours! Sometimes the foal looks o.k. the fist day (this may be a result of the stress hormones of parturition) and only on the second day it is already unable to rise and drink and You may be too late to save it. The most common port of infection is the umbilical stump, therefore good desinfection is very important.

Neonatal Sepsis

Infection can show up in different ways in newborns, from nearly undetectable to severe. Sometimes only some depression is detectable, with fever, but some days later there may be septic arthrits with lameness and distented infected joints (joint disease), or pneumonia (infection of the lung), or encephalitis (infection of the brain).

But many foals show severe signs of sepsis when bacteria overflow the whole foal via blood system and cause cardiovascular shock and - if not stopped by treatment - multiple failure of organs and resulting death. In those foals temperature is below normal (less than 38 degree C), the limbs and ears are cold, mucous membranes are pale or cyanotic. If the shock is severe, the vet has difficulties finding a vein for infusion. 

And even when the foal survives this life threatening condition, it is very likely that chronic diseases of joints and other organs will follow.

Maladjustment Syndrome

Non infectious reasons for a weak or severely depressed foal and also for foals showing abnormal behaviour are mostly a lack of oxygen during parturition. There is a great variation in these foals. They can be nearly normal except for some difference in behavior: They have been described as:  DUMMIES, WANDERERS, BARKERS. A varying degree of disorientation may be all that is seen.

Severe oxygen depletion can also result in a foal that is lying on its side and is showing nearly no response to exogen stimuli. Some foals also show convulsions.

In my opinion DRINKING is the most important part that has to be carefully watched. In the more normal foals You have to ask the following important questions regarding the drinking of the foal:

- Does the foal recognize the dam and is teet seeking direct and effective?

- Is there adequate colostrum and is feeding normal?

- Is there evidence of nasal reflux of milk during or after feeding?

- Does the foal appear to see normaly (does it bump into walls, etc.)?

- Is there milk on the foals face indicating that the foal has at least been seeking the teet?

- Is the mare´s udder full or empty or is there evidence of milk loss over the lower hindleg of the mare?

- Is the suck reflex fully developed? I.e. does the foal´s tongue get the shape of a triangle when it is drinking?

Lack of oxygen results in failure of the nervous system and hence failure of proper reflexes and behaviour (Hypoxic ischemic encephalomyelopathy). Two examples of totally different cases of NEONATAL MALADJUSTMENT SYNDROME will show You the variety of these disease:

The first case was a German riding pony foal that had been born unattented. The owner came into the stable in the morning finding a foal lying flat and unable to rise or sit. I was called, if there is any chance to save the foal. I found the foal severley depressed without reflexes. The foal was given infusions, antibiotics, dexamethasone, (with seizures diazepam whould have been given but was not necessary). A stomach tube was fixed and the owner gave colostrum after my advice. Plasma infusion was given some hours later. Half a day later the foal rose by itself, found the udder without help and drank normally. Everything was o.k. and the foal grew up to a healthy mare.

The same year an Arabian colt was born from my own mare. I attended and helped in delivery. The foal was normal except that it was not able to lie in sternal recumbancy (photo). After one hour it looked o.k. and began its attempts to rise. Soon it showed hunger and seeked for the udder and found it with only a little help. It drank, but milk ran from its nose. I noticed that it did not drink like foals drink normally. The tongue was not forming a V around the teet but the foal drank by using its lips. After some hours it drank normally, but it was already to late: The foal developed aspiration pneumonia and could not be saved despite of all efforts.

The first foal was severley depressed but could be saved, the second had only little deficencies but was lost! In Arabians I notice this second form of neonatal maladjustment syndrome with failure of proper drinking once in a while. Mostly the foal was born unattented and had already been drinking when found by the owner in the morning. Always milk could be seen in the nose. And if looking back You could always observe a kind of depression and disorientation in these foals.

Drinking problems are not always found in maladjustment foals - thanks God. But be careful to find out those with drinking problems, so that You can interfere. Those foals are not allowed to drink at the udder and must get dexamethason and maybe oxygen immediatelly when observing any signs of maladjustment. Colostrum may be given via stomach tube.

                   This foal is unable to lie in sternal recumbancy - don´t waste time to help!

Actions to be taken immediatelly after birth:

Normal Newborn: continue to monitor from distance - avoid interference

Moderate depression: adminster nasal oxygen external  -  rubbing stimulation  -  encourage sternal recumbancy

Severe depression: adminster doxapram  -  nasal oxygen  -  external stimulation  -  encourage sternal recumbancy  -  further respiratory and cardiovascular resuscitiation may be necessary

Nearly dead: adminster artifical respiration (mouth to nose respiration if nothing else is possible)

Signs of neurologic disorders in newborn foals:

behavioral abnormalities including searching for the mare´s udder badly, tongue out, seezing, hyperesthesia on handling (the latter is quite normal in Arabian foals)

persistent chewing movements with hay in the mouth

loss of suck reflex and nursing

weakness and rapid exhaustion, inability to stand or to stand for a longer time, undirected movements or aimless wandering

variable breathing patterns, periods of apnea

barking (well described but seldom present)

central blindness with unequal pupil sizes

opisthotonus (head back), hypotonia (floppy foals)

clonic or generalized convulsions

head pressing

coma or deep sleep

                     Milk is running from the nose