Recognizing Critical Illness in Foals

Is your foal sick, or just napping?

Few things in nature are more inspiring than new foals frolicking around their mothers on a crisp spring morning. Fortunately, things proceed normally almost all of the time. Foals have survived the cold, cruel world much longer than there have been foal-watch teams to worry about them. However, how do we know when things are not right? What are the signs? What can and should be done?

When a foal becomes ill, many of his body systems want to revert back to the warm, safe confines he had in the “mom”. However, the prenatal function of most organ systems is not compatible with life on the outside. When the normal physiological role is absent, the invasion of bacteria, viruses and fungi can cause illness in foals. The term “neonatal septicemia” describes foals with a serious infection in the blood stream. In sick foals, the metabolic retreat to prenatal life can occur rapidly, within just a few hours. The passage that allows blood to flow through the lungs begins to close, so respiratory symptoms are common in at-risk foals. Among the first symptoms noticed are cough, runny nose, high fever and lethargy. The urachus opens again, urine dribbles from the umbilicus, and “my colt is peeing out his belly button” is an alarming report. Gastric ulcers are also seen in these patients and may cause rolling, teeth grinding and increased salivation. Some foals with gastric ulceration may roll up next to a fence or wall so they are lying directly on their back with their feet in the air. In addition, the shunt at the liver is closed again, and metabolic waste products that are normally cleared from circulation by this vital organ begin to increase in the blood. This buildup soon becomes toxic, the life-sustaining mechanisms cease functioning and other potentially fatal events arise.

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There are several things that suggest the foal is at risk for developing neonatal septicemia. Some of these can be quite subtle, so a “well baby exam” during the first day of life by a veterinarian is strongly advised even if everything looks OK. Foals that fail to stand and nurse within two hours or have urine dribbling or swelling at the umbilicus are suspect. In addition, joint swelling and extreme lethargy, sometimes indicated by general weakness or “floppy” ears, are also cause for concern. (It is interesting to note that before the foal can stand for the first time, he must have good control of his ears.) Diarrhea, cough, nasal discharge and fever (a temperature over 101.5) suggest the presence of serious problems. Lethargy can be difficult to assess, as a normal foal will exhibit a cycle of nursing, playing and “power napping” throughout the day. However, a foal that is not easily aroused by human or maternal stimulus or has any of the other symptoms mentioned here should be examined by a veterinarian immediately. Normal nursing behavior is the most important indicator of good health. Failure to stand and nurse normally within two hours after birth, or wandering around the stall “nursing” foreign objects are clear indicators that the foal is in trouble. As the typical mare produces about 4 gallons of milk per day, a foal needs to nurse frequently to ingest this volume. The new foal should be observed closely to be certain that he actually has the teat in his mouth. Even though the foal’s head may be seen under the mare’s flank and sucking noises heard, sometimes he still has not “latched on.” The presence of milk on the newborn’s face is an indication that he may be getting close, but not actually nursing and can be cause for concern.

Roll It!

Colorado State University's Dr. Pat McCue demonstrates how to evaluate a placenta. If the mare’s udder is being nursed regularly, the teats will look clean and be pointing downward or directed north and south. If the foal has not nursed, the teats may have crusty debris still present on the surface, and they may point southeast and southwest, an indicator of a full udder. Normal nursing is repeated in episodes lasting 15 to 30 seconds or longer. Nursing activity for three or four seconds is not adequate, and assistance is warranted. If the foal has not latched on, directing him toward the teat and squirting milk on his nose can help him locate his breakfast. In some cases, however, a stomach tube must be passed by a veterinarian, and the first colostrum delivered in this manner. This will ensure the presence of essential antibodies in his system and provide the immediate nutrition needed until normal nursing patterns can be established. The importance for normal nursing can not be overemphasized as it may be the most critical aspect of survival. As the gut remains porous for the first 12 to 24 hours to absorb antibodies from colostrum, these holes can also allow the passage of bacteria. This is probably the beginning of sepsis, or infection in the blood rather than the old wives’ tale of it coming from the umbilicus, traditionally called “navel ill.” The presence of milk in the intestine triggers the mechanism that closes the large pores in the lining and allows normal absorption of water and other nutrients. The closure of intestinal pores will guard against the introduction of bacteria into the bloodstream, and the antibodies present afford protection against those that may have tried to sneak in uninvited.

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Premature births are relatively uncommon in horses but, as is the case in humans, present severe challenges to survival. Although the normal gestation, the length of pregnancy in a mare is 345 days (the average is 333 to 357 days), some foals prefer their own calendar. Regardless of the duration of pregnancy, foals with a short, velvety hair coat, little body fat or severe weakness are by definition dysmature and at risk for septicemia. This is more common if the gestation is longer than average, rather than shorter than average. Although we may be tempted to induce labor in pregnancies exceeding 400 days, this is very seldom advisable, as these foals aren’t “done” yet.  Forcing their delivery will commonly result in a dysmature foal. Time sufficient for the maturation of all body systems is imperative for neonatal survival. The production of surfactant, a substance that allows the lung to inflate properly, is among the last components to mature in the prenatal horse. This miraculous compound reduces surface tension in the alveoli, the microscopic spaces in the lung that are the location for exchange of oxygen, carbon dioxide and other gases. When you blow up a toy balloon, you will notice that it is fairly difficult in the beginning. However, at some critical point, it gets easy. This is what surfactant does in the lungs, makes it easy to inflate the alveoli. Once the lungs are properly inflated, the foal is absorbing oxygen, and life without the placenta is possible. Dysmature foals often lack adequate surfactant, and severe respiratory problems with septicemia are common. The amazing phenomenon of new life usually proceeds without difficulty. However, if a foal presents with any of the symptoms discussed here, veterinary attention is advised. Most of these cases should be treated as an emergency, so waiting for normal office hours is seldom an option. Many at risk foals can be saved with some simple mare-side techniques that can avoid major problems later. Above all, when in doubt, call your veterinarian.