Foal Prematurity - 763

Case Study of Joey, the Foal

Introduction

• Joey is a 1-hour-old Quarter Horse foal, estimated to weigh around 50 kg (actual weight might be less).

• Presented with a critical condition due to the severe illness of the mare.

• Relevant history includes the mare experiencing a small intestinal obstruction that led to a gastric rupture.

• Emergency C-section performed at 318 days of gestation.

Risk Assessment

• Risk Category: High Risk

  • Factors Contributing to High Risk:

    • Gestational age (318 days considered premature).

    • Maternal condition (mare severely ill due to gastric rupture).

    • Emergency surgical intervention (C-section).

    • Premature foals have increased risk due to underdeveloped systems.

• Discussion points:

  • Importance of evaluating maternal and environmental factors.

  • Risk of anesthesia impact during C-section.

Discussion on Survival Chances

• Decision to Attempt Rescue:

  • Important to evaluate the value of the foal, both financially and emotionally.

  • Consideration of the stress it may cause if the foal is extracted without a chance of survival.

  • Some cases may not warrant intervention if the mare and foal lack significant value.

• Determining Factors for Action:

  • Gestational age, maternal health, potential for the foal's recovery, and overall viability.

Physical Examination Findings

• Condition of Joey at examination:

  • Lethargic and weak (unable to maintain posture).

  • Silky hair coat indicative of prematurity.

  • Vital signs:

    • Temperature: 98.5°F (hypothermic condition).

    • Respiratory Rate: 58 breaths/min (indicating respiratory distress).

    • Pulse Rate: 92 beats/min.

    • Observations of increased respiratory effort with audible crackles in lungs.

    • Mild hemorrhage noted from umbilicus.

    • Mucus membranes darker pink suggestive of potential systemic issues.

    • CRT (Capillary Refill Time): Less than 2 seconds (generally normal).

    • No palpable joint effusion observed.

Initial Assessment and Concerns

• Concerns Identified:

  • Lung development (prematurity affecting lung function).

  • Possible absence of passive transfer of immunity due to emergency situation.

  • Risk of sepsis due to compromised health.

  • Lack of colostrum feeding opportunity given maternal condition.

  • General concerns regarding the functionality of other body systems (kidneys, gastrointestinal tract).

Clinical Signs of Prematurity and Dysmaturity

• Common clinical signs to recognize:

  • Incomplete ossification of cuboidal bones.

  • Silky or fluffy hair coat.

  • Immature lung development and potential respiratory distress.

  • Possible GI complications including meconium impactions.

  • Other signs include low birth weight variances and abnormal head shapes in some cases.

  • Lack of reactivity in physiology and behavior compared to normal newborn foals.

Considerations for Treatment Decisions

• Points for Discussion in Treatment Planning:

  • The cost of treatment must be addressed, usually much higher than initial estimates (possible $15,000 - $20,000).

  • Consideration of long-term care and the commitment required.

  • Availability of referral resources must be assessed based on the condition severity and location.

  • Emotional and practical value of foal in decision making.

  • Quality of life concerns, especially respiratory distress as an indicator of suffering.

• Treatment Options:

  • Discuss potential costs with referring institutions before committing.

  • Evaluate short-term prognosis based on the immediate issues (lungs, systemic function).

  • Long-term prognosis will include musculoskeletal development and ongoing health monitoring.

Referral Decision Making

• Factors influencing referral:

  • Severity of illness and prognosis.

  • Referring veterinarian's comfort level and experience with foals.

  • Economic consideration based on client’s willingness and ability to invest in treatment.

  • Supportive care capabilities in the current practice.

  • The urgency of treatment based on foal’s physical condition (e.g. respiratory crisis).

• Understanding that each situation is unique and requires tailored decision-making process considering all factors.