An owner or foaling attendant should be trained, ready, and able to assist if necessary. It is important to keep track of critical events, such as the time the mare ‘broke her water’, the time the foal was born, and time when the foal first stood, nursed and passed meconium.
The mare and foal should be left alone as much as possible after foaling to allow time for social bonding to occur. The placenta should be saved and examined as this may provide valuable information as to the foal’s in utero environment and potential exposure to pathogens. A foaling kit, emergency contact list, telephone, emergency intervention protocol, and possibly even transportation (i.e. truck and trailer) should be readily available to the foaling attendant.
A-B-C Guidelines for Foal Resuscitation
A specific series of events must occur during and immediately after birth to optimize foal survival (Table 1). Fortunately, these events occur spontaneously in the vast majority of foalings and intervention is not usually required. However, foaling attendants must understand these principles and should be prepared to intervene during a foaling and attend to the immediate needs of the newborn foal if necessary.
Intervention may be indicated in the absence of spontaneous breathing, if breathing is irregular or abnormal, in the absence of a heartbeat, or if the newborn foal is flaccid and non-responsive.
Table 1. The A-B-C Guidelines for the progression of events in a normal foaling and the order of intervention for foal resuscitation are listed below.
Urospermia
| Order |
Event |
| A |
Establishment of an Airway |
| B |
Establishment of Breathing |
| C |
Establishment of Circulation |
•
Have a standardized plan in place for routine care
•
Develop an emergency plan; incorporate local veterinary services
•
Have necessary equipment and supplies on site and readily available
| Brix (%) |
IgG Conc (mg/dl) |
Colostrum Quality |
| >30 |
> 8,000 |
Very Good |
| 20 to 30 |
5,000 to 8,000 |
Good |
| 15 to 20 |
2,800 to 5,000 |
Fair |
| < 15 |
< 2,800 |
Poor |
| Time From Foaling |
Event |
| 1 hour |
Standing unassisted |
| 2 hour |
Nursing from mare |
| 3 hour |
Passing meconium |
•
If the foal was born in an unsanitary environment and the risk of infection is high
•
If the foaling was unattended or unexpected and it is unknown if the foal nursed an adequate amount of colostrum
•
If the mare leaked colostrum for several days prior to foaling
•
If a foal is born to an unvaccinated mare or if the vaccination history of the mare is unknown
•
Clostridium perfringens Type C antitoxin - Escherichia coli antibody. The paste and liquid formulations contain equine origin antibodies against C. perfringens toxins and E. coli bacteria and can be administered orally to newborn foals to prevent clostridial enterocolitis.
•
Equine Coli EndotoxÒ contains antibodies against the bacterium Escherichia coli. It is to be administered orally to foals within 12 hours of birth and is labeled as an aid in the prevention of colibacillosis and septicemia caused by K99piliated E. coli.
Establishment of an Airway
The foal must be able to breathe on its own once it exits the protected environment of the uterus and is detached from the umbilical
cord. Occasionally a foal is born with the thin, greyish-white amnion still covering its nose, preventing normal respiration. An alert foaling
attendant must quickly recognize this problem and immediately remove the amnion from the head and neck area. Failure of the amnion
to be removed from the nostrils of a newborn foal can result in asphyxiation.
There is usually limited fluid or mucus that occludes the upper airway passages of a foal. A majority of the amnionic fluid is probably
pushed out of the respiratory tract (i.e. lungs and upper airways) when the chest is compressed as it passed through the birth canal.
One can ‘strip’ some fluid from the external nares area with simple digital compression with fingers followed by a forward movement.
Rarely, an attendant may have to suction mucus from the nasal passages of a foal using a suction device.
Presence of yellow-brown meconium staining on the newborn foal or the amnion may indicate that the foal could also have meconium in
its airways and could have other issues related to pre- and/or intra-partum stress.
Establishment of Breathing
A newborn foal should take its first breath within a few moments after the chest has passed through the birth canal. If the foal has not
initiated breathing immediately after it was born, the attendant should immediately enter the foaling stall and briskly rub the foal down
with a clean towel. The goal is to stimulate the foal sufficiently to begin breathing. If the foal still has not taken a breath, one can
stimulate the inside of its nostrils with a piece of straw or placement of fingers in its ears.
If these techniques fail, one should quickly begin manual resuscitation efforts preferably using a device designed for respiratory use.
The foal is placed on its side and the cone of the resuscitation device is placed over the nose of the foal. The gasket of the cone
provides a seal against the foal’s face. Once firmly seated, the bag is compressed (EZ BreatherTM device) to deliver air into the lungs
of the foal and then released. The attendant should deliver 10 to 20 rescue ‘breaths’ per minute. An assistant (if available) should put
gentle pressure on the esophagus to prevent air from being forced into the gastrointestinal tract. A brief pause should occur every 30
seconds to check if the foal is breathing on its own. Once the foal is breathing, it should be placed in a sternal position to allow for
expansion of both lung fields.
An oxygen tank (i.e. E-Tank) may be present on many larger broodmare farms so that a newborn foal can be supplemented with oxygen
if needed. Farm personnel should be trained prior to the onset of the foaling season in the use of oxygen supplementation if such a tank
is to be made available.
The normal respiratory rate of a newborn foal may range from 70 to 80 breaths per minute and will gradually decrease to 30 to 40
breaths per minute over the first few hours. Respiratory rate may increase if the ambient environmental temperature is high. The
breathing pattern should be regular and without excessive abdominal effort. A sleeping foal may exhibit an irregular breathing pattern
with periods of apnea that alternate with fast, shallow breathing.
Heart Rate and Rhythm
A heart beat should be evident immediately after birth. The heart rate of a newborn foal is approximately 80 to 120 beats per minute.
This will decrease over a few hours to 40 to 80 beats per minute. To check if the heart is beating in a newborn foal, place a stethoscope
on the lower left side of the chest (behind the elbow) and listen for a heartbeat or place a hand on the lower left side of the chest and
manually feel for a heartbeat.
If a heartbeat cannot be heard or felt in an obtunded foal, call for assistance immediately. Cardiac compressions, performed by a
trained attendant, or emergency medications, delivered under the advice or supervision of a veterinarian, may be indicated in the
absence of a detectable heartbeat.
Rupture of the Umbilical Cord and Umbilical Care
The umbilical cord normally breaks approximately 2 inches from the body wall of the foal when the mare stands or the foal struggles to
rise. There is no reason to break the cord prematurely as long as the mare and foal are lying quietly and there are no obvious
complications. Although it is controversial whether or not any significant amount of placental blood is actually transferred into the foal
following birth, it may be best to allow for that possibility. Consequently, early clamping, tying, or manual disruption of the cord is
discouraged unless absolutely necessary.
If it does become necessary to break the cord, manual rupture can be performed by firmly grasping the cord on either side of the
normal breakpoint and tearing it. Do not attempt to break the cord away from the abdomen of the foal simply by pulling on it. Tearing is
preferable to cutting since cutting does not allow the natural retraction and occlusion of the umbilical vessels, and has been associated
with a higher incidence of excessive bleeding, patent urachus and umbilical infections. Alternatively, an umbilical clamp or umbilical
tape can be applied to the cord approximately 2 inches from the body wall and a pair of scissors used to cut the cord distal to the
clamp.
It is recommended that the umbilical stump be disinfected immediately after the cord has ruptured. This will prevent bacteria from
entering the open umbilical vessels and infecting the newborn foal. Choices for umbilical disinfectant treatment include chlorhexidine,
povidone-iodine, and 2 % iodine. It is currently recommended to use a diluted chlorhexidine solution to safely and effectively disinfect
the umbilical stump of newborn foals. The umbilical stump should be completely immersed in a small container of disinfectant for
several seconds. Disinfectant solutions should not be ‘spritzed’ on or ‘daubed’ on, as these procedures are ineffective at reaching
areas deep within the umbilical stump. Disinfectant treatment should be applied 2 to 3 times per day for 2 to 3 days.
Nursing and Ingestion of Colostrum
Nursing and ingestion of good quality colostrum are critical to the wellbeing of a newborn foal. The foaling attendant and/or farm
personnel should observe the foal to determine if it can stand and nurse on its own or if assistance is required. Thankfully, the vast
majority of foals will stand and nurse unassisted within the first 1 to 2 hours after being born. A few foals will stand unassisted, but may
need some guidance to find the udder. Observation of dried milk on the face and nose of the foal and a full, tight udder on the mare
suggests that the foal is not nursing effectively or maybe not nursing at all. In some circumstances a young, inexperienced mare may not
let her foal nurse and intervention may be needed.
Newborn foals enter the world without antibody protection. Foals are entirely dependent on antibodies absorbed following ingestion of
colostrum in the first few hours of life for protection against infectious diseases, a process called passive transfer of immunity. The
equine placenta does not permit passage of antibodies from the mare to the fetus in utero. A foal is born with a competent immune
system and will begin to produce antibodies of its own within the first few weeks of life. However, exposure of foals to infectious
disease organisms in the first few hours or days of life can have a devastating effect if the foal does not obtain immune protection from
colostrum.
Mares produce colostrum only during the last 1 to 2 weeks of gestation as antibodies are actively transported from their blood and
concentrated in the mammary gland. After nursing colostrum, specialized cells that line the small intestine of the newborn foal absorb
antibodies and transfer them into the foal’s blood. Absorption of antibodies by these specialized cells is greatest during the first 6 to 8
hours after birth and stops by 24 to 36 hours of age.
It is recommended that the quality of a mare’s colostrum be evaluated immediately after foaling. A couple of drops of colostrum are
placed onto the prism of a Brix refractometer and the quality score determined on a percentage scale (Table 2). A high Brix percentage
score is associated with high colostrum antibody content and the foal should receive adequate passive transfer of antibodies. In
contrast, a low Brix score is associated with a low colostrum antibody content and the foal is at risk of failure of passive transfer.
Table 2. Interpretation of colostrum quality based on Brix refractometer score.
Failure of passive transfer (FPT) of antibodies occurs in 10 to 20 % of newborn foals. The most common causes of FPT are poor
quality colostrum and premature lactation. Mares that drip or run milk for several hours prior to giving birth are losing colostrum that is
vital to the survival of their foal. In that situation, it is recommended that colostrum be stripped or milked out of the mare, tested for
quality using a Brix refractometer and saved for the foal. The colostrum should be strained through a filter into a labeled plastic bottle
and either refrigerated or frozen if foaling does not appear to be near. Other causes of inadequate transfer of antibodies include failure
of colostrum production (i.e. due to fescue toxicity), inability or lack of desire by the foal to nurse, prematurity, dysmaturity, foal rejection
by the mare and failure to absorb antibodies that are ingested.
If colostrum of a post-partum mare is tested with the refractometer and determined to be of marginal or poor quality, it would be
beneficial to supplement the foal with frozen-thawed colostrum from another mare or administer a colostrum substitute orally within the
first few hours of life. Early intervention and oral supplementation can eliminate the need for intravenous plasma transfusion later.
Passage of Meconium and Meconium Impactions
Meconium is the first feces passed by a newborn foal and is comprised of digested amnionic fluid, gastrointestinal secretions, and
cellular debris swallowed by the fetus while in utero. It is usually dark greenish brown or black in color, firm pellets to pasty in
consistency and is generally passed within the first 3 to 4 hours after birth. Failure to pass meconium results in significant abdominal
pain in the neonate.
A foal is considered to have retained meconium or a meconium impaction if frequent unsuccessful attempts to pass meconium occur
within the first 12 to 36 hours of life. It has been estimated that 1.5 % of all foals are affected by meconium impactions. Colt foals
reportedly have a higher incidence of meconium impactions than filly foals.
Mild clinical signs are usually apparent within 6 to 24 hours after birth and include failure to completely pass meconium, a progressive
increase in abdominal pain, and frequent posturing and straining to defecate. Affected foals may also be depressed and reluctant to
nurse.
The standard initial treatment for foals with a meconium impaction is administration of an enema. A commercial sodium phosphate
enema (FleetÒ brand or generic equivalent) is safe, easy to administer and generally effective. Enemas should be warmed prior to use
and may be kept in an incubator until needed or warmed to approximately 37° C in a water bath. The protective cap is removed from
the enema bottle, the lubricated tip is gently inserted fully into the rectum, and the plastic bottle is gently squeezed to deliver the
contents. In most instances, foals are administered the entire contents of the enema bottle (100 to 133 mls or approximately 3.5 to 4.5
oz). The rectal mucosa of the foal is very tender and friable. Proper restraint and careful passage of the applicator tip into the rectum
are imperative to prevent trauma.
Breeding farms may choose to routinely give all newborn foals an enema within the first 1-2 hours after birth or may selectively
administer enemas only to foals that do not pass meconium on their own. Either type of management strategy is acceptable. Foals that
do not successfully pass meconium in the first few hours of life should be treated because of the potential for significant complications,
including colic, failure to nurse adequately, and inflammation of the colon and rectum.
If 1 or 2 sodium phosphate enemas fails to resolve a meconium impaction, an acetylcysteine retention enema (ARS E-Z Pass Foal
Enema Kit) may be successful in the medical resolution of meconium impactions.
A solution containing acetylcysteine solution is slowly infused into the rectum through a soft, flexible Foley-type catheter. The catheter is
clamped shut and the solution allowed to remain in the rectum for 15 to 30 minutes before the clamp is opened and the catheter
removed. The foal should be then be monitored for complete passage of the retained meconium and observations continued for the
next 24 to 36 hours. The presence of yellow ‘milk stool’ indicates that meconium has passed completely and that digested colostrum is
now being voided.
Additional therapy may be important in the management of foals with meconium impactions. Ingestion of colostrum should be
monitored as it has a strong laxative effect as well as an invaluable source of antibodies. Foals with colic associated with meconium
impactions may not nurse as vigorously and may be at risk of failure of passive transfer. Additional medications may include
intravenous fluids, analgesics to provide pain relief, and/or other treatments. Rarely, but occasionally, a severe refractory case of
meconium impaction may require surgical intervention.
As with many medical conditions, early recognition and treatment is important in the successful management of meconium impactions.
1-2-3 Rule
As a general rule, critical events in the life of a newborn foal, such as standing, nursing and passing meconium should occur by the time
periods outlined in Table 3.
Table 3. The 1-2-3 rule of events in the life of a newborn foal.
In these situations, it may be warranted to administer antibiotics (as well as supplemental colostrum) to protect the newborn from
infection.
In addition, newborn foals are occasionally administered antibiotics as a preventive measure on farms with a history of early foal
disease or mortality due to specific infectious agents, such as Rhodococcus equi or Clostridium perfringens. Routine use of
antibiotics as a preventive therapy is controversial and without doubt associated with development of antimicrobial resistance.
Plasma and Other Antibody Therapies
Intravenous plasma transfusions may be administered to newborn foals as either prophylaxis to prevent the occurrence of a particular
disease or as medical treatment of an ongoing infectious disease. Examples of diseases for which plasma therapy may be performed
as part of a disease prevention program include Rhodococcus equi and Clostridium botulinum (botulism).
Plasma is routinely administered intravenously to foals greater than 24 hours of age with failure of passive transfer to increase antibody
levels in their blood. Plasma is also commonly given to foals with infectious conditions along with antibiotics and other medications.
There are several other antibody preparations that may also be given to foals in order to prevent or treat specific diseases. Examples
include:
Antibiotics
Routine administration of one injection of an antibiotic to every foal immediately after birth is controversial and generally not recommended. However, there are circumstances in which prophylactic or preventative administration of antibiotics to a newborn foal over a period of several days is warranted, including:
Tetanus antitoxin is an equine-origin product containing antibodies against the toxin of Clostridium tetani, the bacterium that causes
tetanus. Newborn foals are potentially at risk of developing tetanus. The organism is present in the soil worldwide and foals are born
without immune protection against this potentially fatal disease. Foals that are born from mares that have been vaccinated against
tetanus do not require tetanus antitoxin if they have nursed an adequate amount of colostrum. However, foals that are born from
unvaccinated mares will not obtain a significant amount of antibodies against tetanus via colostrum and are consequently at risk of the
disease. At-risk foals should receive one dose of tetanus antitoxin soon after birth, which will usually result in protection against tetanus
for approximately 3 months.
Vitamin E-Selenium
Administration of a vitamin E - selenium preparation to a newborn foal may be beneficial in geographic regions where selenium
deficiency is recognized and where foals are at risk of White Muscle Disease. Treatment of a foal with vitamin E and selenium in a
geographical area with normal levels of selenium is not necessary and could potentially lead to selenium excess.
Testing for Passive Transfer of Antibodies
Early Testing for IgG. Early testing for antibody levels in a neonatal foal can identify potential cases of FPT and allow for early
intervention and medical management. Early testing involves collection of a blood sample from a newborn foal approximately 12 hours
after birth to evaluate circulating IgG levels prior to ‘closure’ of the gastrointestinal tract to antibody absorption. Clinical decisions at 12
hours of age are subsequently based on IgG levels (Table 4):
Later Testing for IgG. Testing a foal at 24 hours of age or more will determine the final extent of passive antibody absorption. It is
critical to understand that no significant amount of antibodies is absorbed if oral supplementation is provided after 24 hours of age.
Foals greater than 24 hours of age identified with FPT require intravenous administration of plasma to successfully increase blood
antibody levels. Although plasma transfusions are commonly performed in foals for disease prevention and medical therapy, oral
administration of colostrum early in the first day of life (i.e. at £ 12 hours of age) is unquestionably easier and less expensive to perform.
Table 4. Antibody levels in foals with adequate passive transfer and failure of passive transfer of maternal immunity.
•
Antibody level of > 800 mg/dl at 12 hours of age indicate that adequate passive transfer of immunoglobulins occurred and no additional testing or intervention is necessary under most management conditions.
•
If IgG level is 400 to 800 mg/dl, the need for intervention and therapy is dependent on potential pathogen exposure and/or the medical condition of the foal. Foals with IgG between 400 to 800 mg/dl born into a clean environment with low pathogen exposure potential and good preventive management practices may not need supplemental IgG.
•
Foals with an IgG of 200 to 400 mg/dl at 12 hours of age are at risk of developing infections and would benefit from IgG supplementation. Frozen colostrum from a colostrum bank can be thawed and administered orally. Commercial equine oral IgG preparations are also available and can be administered along with colostrum.
•
An IgG level of < 200 mg/dl at 12 hours suggests that no ingestion or absorption of colostral antibodies has occurred and colostrum and/or intravenous plasma administration is indicated.
| Foal IgG Concentration |
Interpretation |
| > 800 mg/dl |
Optimal passive transfer |
| 400 to 800 mg/dl |
Adequate passive transfer |
| 200 to 400 mg/dl |
Partial failure of passive transfer |
| < 200 mg/dl |
Complete failure of passive transfer |
Diagnostic tests for evaluation of plasma IgG levels in foals include the single radial immunodiffusion (RID), glutaraldehyde coagulation (GC), zinc sulfate turbidity test (ZST), latex agglutination test (LAT), enzyme immunoassay (EIA) and turbidimetric immunoassay (TIA). The single radial immunodiffusion test is the most accurate test for quantitative measurement of serum or plasma antibody levels. However, results are generally not available for 24 hours or more making it impractical for routine use when rapid results are required. The most common tests used in clinical practice are the SNAP test and TIA test.
A turbidimetric immunoassay (ARS Foal IgG Test) is based on a specific antigen-antibody reaction in which goat anti-equine IgG binds to equine IgG in foal plasma. Specific volumes of foal plasma and goat anti-equine IgG are added to a cuvette containing a buffer solution. The cuvette is subsequently placed into a calibrated spectrophotometer (i.e. Densimeter) and the concentration of foal IgG is determined by the degree of turbidity measured by percent light transmission through the cuvette and converted to mg/dl (Figure 1).
Figure 1. Densimeter with display reading foal IgG level of 629.1 mg/dl.
Early testing of a newborn foal can detect potential cases of failure of passive transfer in time for oral supplementation with frozen colostrum to be effective. A timely diagnosis and early therapeutic intervention will often circumvent a life-threatening medical crisis in a young foal.
Follow-up Care and Other Observations
The newborn foal and dam should be observed carefully by farm personnel for the first 2 to 3 days after foaling to monitor activity level, health, social bonding, and nursing. Normal foals nurse frequently and generally keep the udder of the mare drained. Foaling attendants and farm personnel should be instructed to specifically observe the newborn foal for normal urination and defecation and to alert appropriate personnel if the foal appears to have problems voiding urine or is straining to defecate. The strength and activity level of the foal should progressively increase over time. Foals with medical conditions may become weak, depressed, and stop nursing over a very short time period. Early recognition of changes in the behavior or attitude of the foal may be critical.
Foals that were born following a difficult birth (dystocia) or in a red-bag delivery should be closely monitored for behavior over the first 48 to 72 hours, as hypoxemic events that occurred during foaling may not be immediately apparent. Foals may sustain fractured ribs during a dystocia, assisted foaling, or even an apparently uneventful foaling. Affected foals may exhibit localized swelling, pain, difficulty in breathing, or other problems.
The body temperature of the foal should be measured if the foal appears to be depressed, not nursing, reluctant to move, or less active than normal. The normal body temperature of a newborn foal ranges from approximately 37.2 to 38.7 °C (99.0 to 101.5 °F). A body temperature below or above this range is considered abnormal and appropriate personnel should be notified. Note that it is common for a newborn foal to shiver for 3 to 4 hours after birth to generate heat. In some instances, a young foal may need extra bedding (i.e. deep straw), a blanket, or heat lamps to help it keep warm.
It is recommended that a routine newborn foal examination be performed by a veterinarian within 12 hours after birth to evaluate health status and determine if medical therapy is indicated. As noted previously, a veterinarian should be contacted immediately in the event of a difficult birth, retained placenta, or sick newborn.
The placenta can be evaluated at the time of the newborn foal examination if it has not been looked at previously by farm personnel or if abnormalities were observed. The placenta should be refrigerated if a significant time delay is anticipated between foaling and placental evaluation. A blood sample can also be collected from the foal for measurement of IgG levels, if the timing is appropriate.
Article
Get ready for the foaling season: Care of the Newborn Foal
Patrick M. McCue, DVM, PhD, Diplomate American College of Theriogenologists
Colorado State University
Foaling season is here. Mare owners, foaling attendants and everyone else involved need to understand the general principles involved in newborn foal care. This includes:
