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1.
Despite major advances in our knowledge and ability to treat respiratory diseases in neonatal foals, neonatal respiratory medicine is still in its infancy. It is hoped that this article may serve as a guideline for diagnosis and treatment. Specific antibiotic regimens and emergency procedures are covered in other articles in this symposium. Because management factors play a critical role in the pathogenesis of respiratory disease, education of clients as to their importance would help both prophylactically and therapeutically. The necessity of very careful monitoring of neonates, which is critical to early detection of disease, should be stressed. As respiratory diseases can be fulminant and rapidly fatal, it is imperative not to delay diagnosis and therapy. Thorough examination and implementation of appropriate diagnostic techniques, as well as prompt early referral to a more sophisticated facility when indicated, would prevent many deaths. Although sophisticated support systems are vital for survival of some of these foals, good basic intensive nursing care combined with selection of appropriate drug therapy very early in the course of the disease is all that many foals require and can significantly improve survival rates.  相似文献   

2.
Meconium impactions are only rarely refractory to medical therapy. The purpose of this paper is to examine the outcome of 8 foals that required an exploratory celiotomy to correct a meconium impaction. Between 1984 and 1992, 24 foals were referred with a primary diagnosis of meconium impaction. All foals were treated medically prior to and following referral. Of the 24 foals, 8 had impactions requiring surgical intervention. Exploratory celiotomies were performed, and the impaction was reduced manually or by enterotomy. Follow up information was available on 7 foals. All survived surgery and were discharged. Four of the 8 foals matured and raced. Two foals were euthanatized due to extensive serosal adhesions and one foal was euthanatized due to an unrelated orthopedic condition. Our results support the decision for an exploratory surgery only after aggressive medical therapy has failed. Several treatment options have been developed in recent years that have reduced the number of foals that may require surgery.  相似文献   

3.
The presentation of a premature, neonatal foal affected with respiratory distress and seizures represents a difficult diagnostic and therapeutic challenge often best addressed by the provision of appropriate emergency care followed by prompt referral to a well‐equipped critical care facility. Veterinary management of the premature foal described in the accompanying report was complicated by the development of sepsis and pulmonary failure. The development of pulmonary emphysematous bullae was identified during the course of the foal's treatment and probably contributed to its clinical deterioration. Diagnostic imaging modalities that may be used for the diagnosis of respiratory distress in neonatal foals include thoracic radiography, ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI). Both CT and MRI require general anaesthesia. The likelihood of a successful outcome for the foal in this report might have been improved by the provision of urgent veterinary care and referral to the critical care facility earlier in the course of its management. Important early indicators of the need for urgent veterinary care in this case included the foal's prematurity, inability to stand, and the need to provide manual support to facilitate nursing from the mare's udder. Foals affected in this manner should warrant treatment with broad‐spectrum antimicrobials, circulating volume maintenance, immunoglobulin support, and the use of a nasogastric tube to facilitate nutritional support.  相似文献   

4.
Cardiovascular or pulmonary system failure in neonatal foals requires rapid recognition and initiation of cardiopulmonary cerebral resuscitation (CPCR). Foals may require resuscitation immediately after birth or after arrest from progression of a disease process such as severe sepsis or septic shock. Initial treatment is aimed at establishing an airway and providing ventilation. Circulation is provided by closed-chest compressions. Circulatory access is important to provide intravenous fluid and pharmacologic therapy for cardiovascular support. Ventricular fibrillation and pulseless ventricular tachycardia are arrhythmias not commonly recognized with arrest in foals, whereas asystole and cardiovascular collapse are frequently encountered. Training of personnel, preparation of supplies, and organization during CPCR is essential to a successful outcome.Most of the information used for CPCR in neonatal foals is derived from human medical research and clinical medicine. As new advances are made in human neonatal and pediatric CPCR, many of these treatments and techniques can be applied to foals. This article reviews currently available CPCR guidelines in foals and highlights new perspectives in human medicine that may be applicable to foals.  相似文献   

5.
Cystic hematomas were diagnosed in 3 neonatal foals. In all 3 foals, cystic hematomas resulted from umbilical trauma or thrombocytopenia. Findings in these foals suggest that cystic hematoma should be included in the differential diagnosis of hematuria in neonatal foals. Management of cystic hematomas includes both medical and surgical options.  相似文献   

6.
Neonates can have a variety of gastrointestinal disorders, primary and secondary in nature. Important primary disorders include con-genital abnormalities and meconium retention. One of the most important secondary lesions is generalized ileus. Gastric ulceration can occur as a primary or secondary event. This article addresses the pathophysiology, diagnosis, and treatment of gastrointestinal problems commonly observed in neonatal foals.  相似文献   

7.
Sepsis is a major cause of death in neonatal foals and, in recent years, significant progress in the understanding of the underlying pathophysiology has been made. To achieve a successful outcome, early diagnosis and treatment focusing on supporting vital functions and neutralising the effects of the causative organisms are essential. The pharmacokinetics of many drugs differ in neonatal foals and more information for appropriate dosing of antimicrobial and anti‐inflammatory drugs for neonatal foals is now available to guide clinicians in choosing the best dosages. Prevention remains difficult and focuses on early recognition while prophylactic use of antimicrobials is discouraged.  相似文献   

8.
Objective – To investigate the association between blood lactate concentration, measured at admission and following 12–36 hours of treatment, and age, diagnosis, and survival in neonatal foals. Design – Retrospective, observational study. Setting – Two equine referral hospitals. Animals – One hundred and twelve foals ≤96 hours of age were included. Interventions – Arterial or venous blood samples were obtained from all foals at admission and surviving foals at 12–36 hours. Measurements – The lactate concentration (LAC) was recorded at 2 time points: admission (LAC‐Admission) and 12–36 hours following treatment (LAC‐24 hours). Main Results – LAC decreased by 0.05 mmol/L for each increased hour of age at presentation. Premature/dysmature foals demonstrated increased odds of nonsurvival of 55% for each 1 mmol/L increase in LAC‐Admission while foals with major diagnoses of neonatal encephalopathy (NE), enteritis and ‘Other’ had increased odds of nonsurvival of 52%, 113%, and 247%, respectively, for each 1.0 mmol/L increase in LAC. Blood‐culture positive foals had significantly lower LAC than blood culture negative foals. LAC‐Admission and LAC‐24 hours were significantly larger in nonsurviving foals. LAC‐Admission of >6.9 mmol/L and LAC‐24 hours >3.2 mmol/L, respectively, correctly classified 85.6% and 94.1% of cases as survivors or nonsurvivors. No differences were found when the 24‐hour change in LAC was investigated in terms of outcome, age at admission, or major diagnosis; however, LAC‐24 hours remained significantly associated with survival. Conclusions – Admission or persistent hyperlactatemia is associated with a nonsurvival. Younger foals, premature/dysmature foals, and foals with neonatal encephalopathy had the largest LAC.  相似文献   

9.
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10.
Colic in neonatal foals is common and unusual causes of colic are not rare. The case reported in this issue by Tapio et al. (2012 ) is a good example of an unusual cause of neonatal colic which presents both a diagnostic challenge and unusual consequences. Gastrointestinal disease, especially colic, ranks as one of the most common reasons why foals require veterinary attention during their first week of life, beyond the initial post natal examination. Foals with colic present a special diagnostic challenge, especially to the practitioner who might not have extensive experience in neonatal medicine. With the often rapid progression of neonatal diseases it is important to make a rapid and accurate assessment.  相似文献   

11.
OBJECTIVE: To assess microorganisms isolated from blood specimens obtained from critically ill neonatal foals and to evaluate their antimicrobial susceptibility patterns. DESIGN: Retrospective study. ANIMALS: 543 neonatal foals. PROCEDURE: Medical records of foals that were < 1 month old and were admitted to a referral neonatal intensive care unit were reviewed for results of bacteriologic culture of blood and antimicrobial susceptibility patterns. RESULTS: At least 1 microorganism was isolated from 155 of 543 (28.5%) foals. Escherichia coli was the most commonly isolated bacterium. A single gram-positive organism was detected in 49 foals. Although 90% of the E coli isolates were susceptible to amikacin, some gram-negative and gram-positive organisms had resistance against multiple antimicrobials. CONCLUSIONS AND CLINICAL RELEVANCE: Gram-negative bacteria remain the most common isolates from blood of neonatal foals; however, gram-positive organisms were also found, and with greater prevalence than reported elsewhere. Susceptibility patterns may vary, and resistance to multiple antimicrobials may develop. This is especially true for organisms such as Enterobacter spp and Enterococcus spp. Prudent empirical treatment for neonatal sepsis should include broad-spectrum antimicrobials.  相似文献   

12.
Differentiation between infectious and noninfectious disease and rapid initiation of accurate treatment are essential in managing diseases in the neonatal and young foal. Identification of useful inflammatory markers for these purposes is, therefore, of great importance. The aim of this study was to compare the responses of the acute phase protein serum amyloid A (SAA) with the responses of fibrinogen and total leucocyte and neutrophil counts in infectious diseases encountered in the young foal, and to assess whether SAA measurements give additional information useful in the management of these diseases. In a prospective study, foals (n = 25) showing clinical signs indicative of infectious disease were blood sampled on admission and then daily or every second day during hospitalisation. The main presenting signs were neonatal weakness (n = 9), pneumonia (n = 6) and diarrhoea (n = 10). SAA and fibrinogen concentrations on admission were higher in foals with bacterial infections (n = 8) than in foals with nonbacterial or uncertain diagnoses (n = 17). On admission, weak foals with negative blood cultures (n = 3) had normal SAA and fibrinogen concentrations and varying total leucocyte and neutrophil counts. Foals with positive blood cultures (n = 2) had markedly increased SAA, decreased or increased fibrinogen concentration and leuco- and neutropenia. Those with ambiguous blood cultures (n = 3) had moderate to markedly increased SAA concentrations and normal fibrinogen concentration, leucocyte and neutrophil counts on admission. All foals with negative or ambiguous blood cultures recovered and had normal or decreasing SAA concentration on discharge. Both foals with a positive blood culture were subjected to euthanasia. One foal born with equine herpesvirus-1 infection had moderately increased SAA and normal fibrinogen concentration and leuco- and neutropenia. Foals with Rhodococcus equi pneumonia had increased concentrations of all parameters on admission. On discharge, recovered foals had normal SAA concentrations, whereas fibrinogen and total white blood cell count and neutrophil counts were still increased. There were no consistent inflammatory changes in the parameters measured in diarrhoeic foals and there was no statistical difference between rotavirus-positive (n = 4) and -negative (n = 6) foals in this respect. The results of this investigation suggest that SAA might be an aid in the differential diagnostic procedure of neonatally weak foals and in foals with diarrhoea as the main presenting clinical sign and that SAA measurements could add information in the monitoring of treatment in Rhodococcus equi pneumonia by responding more rapidly than the markers used to date.  相似文献   

13.
Rhodococcus equi is an important respiratory pathogen of young foals for which a vaccine has long been sought. Two major impediments to effective vaccination are the functionally immature type I immune responses of neonatal foals and early exposure to the bacterium via the environment. Despite these obstacles, it appears that under specific circumstances foals can develop a protective immune response. In this study we investigated the protective mechanisms behind oral inoculation of foals with virulent R. equi bacteria. Two foals receiving an oral inoculum demonstrated accelerated development of R. equi specific cytotoxic T lymphocytes (CTL) as evidenced by significant lysis of R. equi infected, ELA-A mismatched cells at 3 weeks of age. As in a previous study, CTL were not detected until 5-6 weeks of age in two control foals. At each time point the ability of foal peripheral blood mononuclear cells (PBMC) to produce IFN-γ following stimulation with live R. equi or extracted cell wall lipids was similar to that of an adult horse control and between foals, regardless of treatment. These results provide a potential mechanism of protection which has previously been shown to occur following oral inoculation, and suggest that the early detection of CTL may be a useful marker for induction of protective immunity.  相似文献   

14.
OBJECTIVE: To determine risk factors for Clostridium piliforme infection in neonatal foals on a Thoroughbred breeding farm in California. DESIGN: Case-control and retrospective cohort studies. ANIMALS: 322 neonatal Thoroughbred foals either born on the study farm or born elsewhere but traveled to the farm with their dam during the 1998, 1999, and 2000 breeding seasons. PROCEDURE: Mare and foal records from 1998, 1999, and 2000 were examined, using case-control design methods to determine variables associated with increased risk of C. piliforme infection in foals. Important risk factors identified in the case-control study were then reevaluated by use of a retrospective cohort design, using data from all neonatal foals present on the farm during the 3-year study period. RESULTS: Foals born between March 13 and April 13 were 7.2 times as likely to develop C. piliforme infection as were those born at any other time of the foaling season. Foals of nonresident (visiting) mares were 3.4 times as likely to develop disease as were foals born to mares that were permanent residents of the study farm. Foals of mares < 6 years of age were 2.9 times as likely to develop disease as were foals born to older mares. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this research can be used to better understand the epidemiologic factors of C. piliforme infection in horses. High-risk foals can be closely monitored to aid in early diagnosis and treatment, resulting in the best possible clinical outcome for affected individuals.  相似文献   

15.
Infection with Rhodococcus equi is an important cause of pneumonia in foals, but other organ systems may also be affected. The intracellular presence of R. equi and the formation of granulomatous and suppurative inflammatory tissue mean that prolonged treatment is needed. The pharmacological properties of the combination of erythromycin and rifampicin have improved the survival of foals infected with R. equi; however, erythromycin can cause adverse reactions in foals and mares, which has prompted the search for alternative therapies. The combination of azithromycin or clarithromycin with rifampicin seems to be a promising alternative. However these combinations are expensive and adverse effects remain to be determined, especially in the dams of treated foals. Thus correct diagnosis and appropriate use of drugs are essential for the treatment of R. equi infection in foals.  相似文献   

16.
This study was conducted to develop an equation for the prediction of outcome in neonatal foals undergoing treatment in an intensive care unit (ICU). Fifty-three physical examination, historical, and clinicopathologic variables were analyzed from the records of 99 neonatal foals (<14 days of age) treated in the neonatal ICU of the Equine Medical Center. The outcome was recorded and the results were categorized into either surviving or nonsurviving groups. The mean values for the 2 groups were compared, and variables that differed significantly between the two groups were retained and used to construct a logistic regression equation. Retained variables were heart rate, temperature, and neutron phil count. The predictive equation then was tested prospectively in 2 additional groups of foals from 2 separate ICUs. The predicted outcome was compared to the actual outcome, and performance variables were calculated. Sensitivity (.83), specificity (.87), negative predictive value (.72), and positive predictive value (.93) were determined for foals from one neonatal ICU; the sensitivity (.83), specificity (.44), negative predictive value (.44), and positive predictive value (.83) were lower for foals at a second, separate ICU.  相似文献   

17.
Objectives: To describe and compare admission colloid osmotic pressure (COP) measurement using both direct and indirect methods in neonatal foals under intensive care, and to evaluate for associations between COP and clinical/clinicopathologic parameters. Design: Prospective study. Setting: Intensive care unit at a veterinary medical teaching hospital. Animals: Twenty‐six critically ill neonatal foals were studied. A control group consisted of 9 clinically healthy neonatal foals. Interventions: Clinicopathologic data were collected at the time of admission. COP was measured directly using a colloid osmometer. Indirect COP was calculated using equations by both Landis–Pappenheimer (L–P) and Thomas and Brown. Measurements and main results: Measured admission COP values were 17.1±4.3 and 17.7±2.4 mmHg in critically ill and control foals, respectively, and these values were not significantly different. Critically ill foals with blood lactate concentrations >3 mmol/L had lower COP values than those with lactate ≤3 mmol/L. There was close agreement between indirect COP values calculated using the L–P equation and direct COP values measured in control foals (mean error=0.0±1.3 mmHg; R2=0.87). However, indirect values were not as predictive of direct COP in critically ill foals (mean error=0.8±3.8 mmHg; R2=0.64). As COP values increased, the indirect method tended to overestimate COP, whereas at lower values it slightly underestimated COP. Conclusion: While the L–P equation was a close approximation of direct COP in healthy foals, direct measurements of oncotic pressure cannot be replaced for monitoring of critically ill foals. Critically ill foals with higher lactate concentrations had lower COP values, suggesting a possible relationship between COP and lactate.  相似文献   

18.
Little is known about the normal or pathologic yeast flora in healthy and critically ill neonatal foals. The aims of this study were to evaluate the yeast flora colonizing the mucous membranes of the digestive tract (oropharynx and rectum mucous membranes) of healthy and hospitalized foals and to find out risk factors involved in yeast colonization of foals referred to a neonatal intensive care unit. A total of 240 swabs were collected from 21 healthy (group A) and 39 sick (group B) foals. In 14 of the 60 foals, yeast was isolated in at least one sample (23.3%): 3 of the 21 foals (14.3%) were positive in group A and 11 of 39 foals (28.2%) were positive in group B. The yeasts were isolated from rectal swabs obtained from none in healthy foals, whereas 5 of the 39 sick foals were positive; however, this difference was not statistically significant. No significant difference was also detected regarding oropharyngeal swabs between healthy (3/21) and sick (10/39) foals. The risk factors significantly associated with the isolation of yeasts from rectal swabs were female sex, treatment with oral antibiotics, and stressful diagnostic–therapeutic procedures. The only risk factor significantly associated with the isolation of yeast from oropharyngeal swabs was the treatment with antacids and gastroprotectants. The results show that fungi present in the gastrointestinal tract of neonatal foals were mainly environmental yeasts and suggested the absence of a stable fungal colonization. Candida was the genus frequently isolated in hospitalized foals, just as it is isolated in critically ill human neonates.  相似文献   

19.
In an effort to identify improved methods for diagnosis of infection in the neonatal foal, clinical records from 38 septicaemic foals of less than one week of age were examined for trends in history, physical examination and clinicopathological findings. The survival rate of septicaemic foals, 26 per cent, was markedly less than the rate for all other foal admissions. Blood cultures were valuable in diagnosis and treatment of septicaemia and identified a preponderance of Gram-negative infection. Zinc sulphate turbidity test results were abnormally low in all septicaemic foals tested. The clinical course was often distinguished by severe complications and multiple organ dysfunction, leading to death. Conditions present in the mare pre-partum resulted in weak or diseased foals; bacterial placentitis, vaginal discharge and premature lactation were most common. There was no single diagnostic criterion of the septicaemic foal. Fever was not a consistent finding. The most useful white blood cell parameters were neutropenia, the presence of band neutrophils (greater than 0.2 X 10(9)/litre) and toxic changes in the neutrophil population. Hypoglycaemia, metabolic acidosis and hypoxaemia were also common findings.  相似文献   

20.
The medical records of 20 neonatal foals in which exploratory celiotomies were performed for gastrointestinal disease were reviewed. In all 20 foals, persistent pain and/or progressive abdominal distension were the primary clinical findings influencing the decision to operate. However, ancilliary laboratory data were important to the proper medical management of these foals during anaesthesia and following surgery. Surgical diagnoses of the 20 foals included ileus (nine foals; 45 per cent), small colon obstruction (five foals; 25 per cent), large colon displacement (three foals; 15 per cent), small intestinal displacement (two foals; 10 per cent), and perforated gastric ulcer (one foal; 5 per cent). Seventeen foals were recovered from anaesthesia, 13 of these were discharged from the hospital, seven were alive six months or more following discharge. Sepsis was the cause of death in six of the 10 foals that died following recovery.  相似文献   

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