A foal admitted to a neonatal intensive care unit today is three times more likely to survive than one who was admitted in the 1980s, according to a new study from the University of Florida.

Researchers examined the records of 1,065 foals treated in the university’s neonatal intensive care unit between 1982 and 2008, compiling data on the reason for admission, clinical details of each case and variables that could have affected the likelihood of survival.

The most common reasons for admission to the clinic were diarrhea, neonatal encephalopathy (altered mental state or dysfunction of the brain), dysmaturity (including premature foals and foals that failed to fully develop in utero despite a normal gestation time), and sepsis/SIRS (generalized infection). Nearly 50 percent of foals had more than one problem. Although sepsis/SIRS was listed as the primary diagnosis for only 113 foals, it is a common problem, with 60 percent of the foals admitted meeting the study criteria for sepsis/SIRS.

Compared to foals who survived to be discharged, nonsurvivors were significantly more likely to have multiple problems and had a higher number of concurrent disorders. Among foals who died or were euthanatized, 83 percent had sepsis (bodywide infection), compared to 52 percent of survivors. “Foals can become infected through the gastrointestinal tract, umbilicus or respiratory tract,” explains Chris Sanchez, DVM, PhD. “Many, but not all, have failure of passive transfer first.”

The most encouraging news to come from the data, however, was the sharp increase in survival rates among foals born in successive decades. Specifically, in the 1980s, 59 percent of youngsters survived to be discharged, and in the 1990s the rate was 69 percent. By the 2000s, 81 percent of foals admitted to the neonatal intensive care unit survived. 

This relative increase remained even when data was adjusted for disease severity or to exclude foals that were euthanatized, which indicates the increase is due to the quality of care delivered rather than admission of a healthier population of foals or changing attitudes among owners regarding euthanasia.

The study was not designed to identify the specific improvements in care that led to higher survival rates, but Sanchez says she’s encouraged by the progress. “Obviously, the trend will flatten out eventually,” she says. “I’m not sure how much higher we can get the rates, but I’m certainly happy to try!” 

Reference: “Factors associated with outcome and gradual improvement in survival over time in 1065 equine neonates admitted to an intensive care unit,” Equine Veterinary Journal, January 2017

This article was originally published the April 2016 issue, Volume #475 of EQUUS magazine