Neonatal Nanny Vets: Spring Foals Meet Veterinarians Ready to Help Them Survive--and Thrive

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While the safe guess is that the 2011 foal crop for sport and recreational horses will be down in numbers, it's equally safe to say that there has never been a crop of foals whose health will be so well-tended if something goes and their caretakers can get them to the hospital. Private and university neonatal (newborn) care centers have cropped up around the United States, and the science of caring for a newborn foal is continually progressing on the local level as well.

A mare and foal depend on humans to help them when things go wrong during or following birth. (Meneer Zjeroen photo)

A mare and foal depend on humans to help them when things go wrong during or following birth. (Meneer Zjeroen photo)

Who doesn't want to see a sick foal make it? It's hard to imagine a more emotionally-challenging role for a veterinarian to accept, and it's a red letter day at The Jurga Report when we can share some new information with you, courtesy of an old friend and well-known authority on the subject, Dr. Pamela Wilkins, who is now a professor of equine internal medicine and emergency/critical care the University of Illinois College of Veterinary Medicine.

Interspersed with some information from Dr. Wilkins are several videos showing some of the state-of-the-art equine neonatal facilities at private equine hospitals here in the United States and in England, and two hospital situations where foals were cared for under special circumstances.

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Veterinarians at Rood and Riddle Equine Hospital in Lexington, Kentucky are proud of their neonatal specialization. Located in the middle of the highest-density center of Thoroughbred breeding farms in the world, this center is a busy place each spring. It's a short drive to Rood and Riddle for most of the big Thoroughbred farms, but sick foals of all breeds may be referred, and some may travel great distances to get there.

Dr. Wilkins' latest paper on the challenges of neonatal medicine is published in the journal Clinical Laboratory Medicine. You won't find it on the shelves at Barnes and Noble so I will share a little bit of Dr. Wilkins' insights into the intricacies of working with newborn foals.

Like any other newborn, the neonatal horse can be a challenging patient. Its immune system is still under construction, its blood chemistry can vary wildly, and - like most infants - it wants to stay close to mom. (That's where those purpose-built neonatal care centers come in at our universities and vet hospitals--they provide comfortable surroundings for both the mare and foal, while allowing medical staff safe access to the foal, and the foal close access to life-support or monitoring equipment that would be difficult to set up in a normal stall.)

Sickness can play havoc with a foal's blood chemistry, Wilkins said. Teasing out the causes of these changes requires that the veterinarian first understand what is normal in a newborn horse, and then how it can go wrong. To help address current gaps in knowledge, Wilkins regularly conducts blood tests or tests of the musculoskeletal system, such as X-rays and CT scans, on healthy foals. She feels that this is necessary to determine how the body chemistry or physiology of foals differs from that of an adult horse--or from that of a sick foal.

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Newmarket Equine Hospital in England opened last year on a new campus near the National Stud. Internal medicine, reproduction, and emergency care for newborn foals are specialist services at this hospital. The clinic's patient during filming, however, was not one of the local Thoroughbreds but a heavy horse mare.? It takes all kinds!

"Roughly three to seven percent of newborn foals are going to have some kind of significant health issue in the first month of life," Wilkins said. "And because our patients can't talk to us, we have to figure out what's wrong with them based on physical examination and testing and histories given by their owners."

The paper also offers guidance in the use of portable "point of care" devices to measure and monitor a sick foal's changing health status. Such tools can offer immediate results in the field and cut costs associated with care. But the practitioner needs to know how use each device and interpret the results, Wilkins said.

"For example, foals with severe infections can have a very, very low or a very high glucose level," she said. Low blood glucose could be the result of the foal not taking in enough nutrients from its mother. Or the animal may not be able to make use of the glucose that is already stored as glycogen in its body. It's the practitioner's job to find out what's going on, she said.

To do that, veterinarians must understand the normal fluctuations in levels of glucose and other "biomarkers" of health or disease, Wilkins said.

"Blood glucose levels are going to be different between the normal, healthy adult horse and the healthy foal," she said. "And they're going to be different at different stages of the foal's life." Hormones, immune cells, red blood cells, protein levels, enzymes and electrolytes all vary between the adult and the infant horse, according to Wilkins. And many of these markers change as the foal matures and grows.

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What are a foal's chances when there is no high-tech equine medical center available? What happens when the owner can't afford the university fees, or if the mare and foal might not survive a long trailer ride to a specialist neonatal center? Dr. Susan Mende of Wolf Creek Equine Clinic in Maryland shares her insight on a sick Clydesdale foal. She opted not to transfer the mare and foal to a specialist center. Find out why.

But the challenges of treating sick foals don't end there, she wrote. A horse, even a foal, is a big, precocious animal.

"Horses are a prey species, so they have to be able to get on their feet and run pretty quickly after birth," she said. "The older and slower I get, the harder it is to approach them. You spend a lot of time on your knees dealing with them, and they can kick. I get bruises all over my body during foaling season and I have no idea where they're from because I'm focused on what I'm doing."

Add a very protective mother to the equation, and the task gets even trickier.

"The mom needs to be there," Wilkins said. "She gets really upset if she's not."

So when a foal comes into the hospital for critical care, the mother comes too. And like any mother with a sick baby, she hovers.

Stop and think about that: the mother may be a Welsh pony or a Clydesdale. A large-animal veterinarian who takes on a neonatal emergency has to be prepared for both.

"Figuring out a way to keep mom from pulling the IV lines out and getting upset when you're between her and the baby, that takes some doing," Wilkins said. "The mothers don't sleep; they don't lie down; they don't rest. They're on their feet with their heads hanging over their babies most of the time. So it's tough for them."

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Neonatal medicine is not limited to internal medicine. A common complication of young foals is excessive tension or laxity of the tendons in the legs, known as flexural deformities. Some are quick to correct themselves as soon as the foal is moving around and bearing weight correctly on its limbs, while others require some intervention from veterinarians and farriers working together. This video features Angel and Sunny, two twin foals born in California last year. They were long-term patients at the Helen Woodward Animal Center's equine hospital and even had their own live video stream from their stall. This short video provides a general overview of corrective therapy for tiny Angel, how it went wrong, and what measures were taken to correct it.

If a foal needs surgery, the medical staff will sedate the mom until the foal is back at her side.

Wilkins' patients may be the progeny of racehorses or performance horses, but many are also just people's pets, she said. The cost of care can be high, so owners with a strong economic or emotional incentive are most likely to bring a critically ill foal to the hospital.

Despite the many challenges, Wilkins loves the work.

"Foals are just wonderful, wonderful creatures," she said. "I can't imagine working with anything else in my life."

The Equine Neonatal Intensive Care Laboratory: Point-of-Care Testing by Pamela A. Wilkins DVM, MS, PhD is published in Clinics in Laboratory Medicine Volume 31, Issue 1 , Pages 125-137, March 2011. The abstract is available to be read online at no charge and the full article may be purchased or read by subscription.

To learn more about equine neonatal medicine, reference books that are available include:

Equine Neonatal Medicine: A Case-Based Approach Equine Neonatal Medicine: A Case-Based Approach by Paradis

" target="_blank">Equine Neonatal Medicine and Surgery by Knottenbelt, Holdstock and Madigan

" target="_blank">Color Atlas of Diseases and Disorders of the Foalby McAuliffe and Slovis

The Jurga Report thanks Dr Wilkins, the University of Illinois College of Veterinary Medicine, the producers of the videos, and all the vets who are working so hard this spring to help their clients' foals get off to a healthy start in this world.