Neonatal Dz III

Lecture Overview

• The session will cover:

  • Finishing neonatal diseases in critical care.

  • Discussion on equine endocrinology.

• Transition from previous lectures will entail reviewing Joey, a one-hour-old Quarter Horse colt.

Case Study: Joey the Colt

• Joey was born via C-section after 318 days of gestation, indicating he is premature.

• The focus is on decision-making regarding referral, stabilizing Joey before transport, and assessments at the referral institution.

Initial Assessment at Referral Institute

• Clinical presentations identified include:

  • Prematurity (diagnosis confirmed by gestational age).

  • Potential issues with lungs, joints, kidneys, and gastrointestinal tract appearing due to immaturity.

  • Failure of passive transfer confirmed as no colostrum was provided before transport.

Diagnostic Plan for Joey

• Proposed diagnostics included:

  • Chest radiographs to assess lung condition.

  • Radiographs of carpus and tarsus to evaluate joint development.

    • Noticed variability in ossification between joints.

  • CBC and chemistry panel to assess overall health, specifically:

    • Neutropenia with toxic changes indicates possible infection.

    • IgG level check to assess passive transfer status (feasibility discussed as foal likely unprotected).

  • Arterial blood gas test to evaluate lung function and metabolic status.

    • Highlighted preference for arterial over venous blood gas.

  • Sepsis score assessment for evaluating infection likelihood based on clinical and lab data.

Radiographic Findings

• Radiographs showed:

  • Immature lungs with possible indications of pneumonia (differentiation often unclear).

  • Tarsus imaging results suggested incomplete ossification. Comparisons necessary to ascertain whether the process is septic or developmental.

Continuous Problem List

• Updated concerns when diagnostic results arrive:

  • Prematurity and immature lungs confirmed as primary concerns.

  • Delay in ossification noted.

  • Likely sepsis as indicated by blood tests; proactive interventions necessary.

  • Presence of azotemia, needing clarification on potential pre-, post-, or renal origins.

Treatment Considerations for Joey

• Key treatments discussed:

  • Addressing prematurity through oxygen therapy, plasma administration, and nutritional support.

  • Antibiotic therapy prioritized due to infection risk despite CBC results.

  • Maintaining cautious fluid management to avoid overload, especially important due to immature lungs.

  • Importance of GI protection due to high risk of gastric ulcers in sick foals.

Importance of Colostrum

• Emphasized significance of colostrum in passive immunity transfer, with IgG levels needing monitoring post-administration of colostrum/plasma.

Prognostic Indicators for Joey

• Discussed indicators impacting prognosis:

  • Lung function and ossification status have short- and long-term implications for health and athletic potential.

  • Established that high sepsis scores correlate with decreased chances of survival post-referal.

Treatment Protocols

• Recommendations summarized:

  • Antimicrobial regimen: Broad-spectrum, bactericidal must include coverage for Gram-negative and Gram-positive bacteria. Key options discussed:

    • Penicillin and aminoglycosides, with nephrotoxicity considerations noted.

    • Advantages of third-generation cephalosporins cited for broad coverage with lower toxicity risk.

Neurological and Musculoskeletal Management

• Debate on splinting vs. other management strategies for maintaining joint integrity in premature foals. Noted concerns surrounding immobilization effects on overall health (e.g. pneumonia increases).

• The ultimate reconciation of different treatment strategies reflects the collective input and experience of the veterinary team.