Dr. Laurie Metcalfe was born and raised in Madison (WI, USA) where she grew up there with her identical twin, Jen, and their Arabian horses. She is an ambulatory veterinarian with Rood & Riddle Hospital in Lexington, Kentucky (USA). Dr. Metcalfe specializes in neonatal medicine, enjoying foals as well as herd health and general medicine. She is married with two children- a boy, Samuel born in 2011 as well as a girl, Ella born in 2013, and enjoys spending time with them and their Great Dane.
Q - Please define Neonatal Care for Foals? Do all foals require neonatal care? What are the main cases in which neonatal care is advised?
A - Merriam-Webster.com defines NEONATE as : a newborn child or mammal. The “Neonatal Period” is the time when the newborn undergoes a physiological adjustment from the uterine environment to extrauterine life. In humans this is considered from birth to one month, however in the more precocious equine, we generally consider this to be the first 7 days of postnatal life. Therefore when considering “neonatal care” we are referring to the routine preventative care and initial assessment of the newborn foal within the first 24 hours of life as well as any further follow up and treatment warranted based on physical exam and basic bloodwork. All foals should be examined by a veterinary professional as there are many problems that begin with very subtle discrepancies that an owner may not become aware of until disease is advanced.
Q - “Neonatal Maladjustment Syndrome” (“Dummy Foal Syndrome”) is becoming an increasing problem seen in the Thoroughbred breeding industry. What is “Neonatal Maladjustment Syndrome” and what causes it? Is it preventable, and how is it treated?
A - Neonatal Maladjustment Syndrome (“Dummy Foal Syndrome”) is not necessarily a disease per se but a syndrome used to describe newborn foals that exhibit behavioral and/or neurologic abnormalities resulting from a hypoxic insult (inadequate oxygen supply). Neonatal Maladjustment Syndrome (NMS) is more obviously associated with an adverse event at time of foaling, such as a dystocia or premature placental separation (“red bag” foaling), but is also observed in many foals that have not had an obvious periparturient (around the time of foaling) issue. Although frustrating, often a clear cause goes unidentified.
Treatment of NMS foals is largely supportive and will depend on how severely the foal is affected. Many will require extensive nursing care, some of which can be performed at the farm, but more extensive critical care may require referral to a clinic for continuous monitoring. Although there are no magic formulas to prevent NMS, the most significant thing an owner and veterinarian can do is monitor and recognize early any problems occurring during the mare’s pregnancy. In addition, foaling should ideally be attended for rapid intervention at the first sign of trouble.
Q - What should be the areas of consideration when a breeder or veterinarian decides to proceed with neonatal care?
A - As the Thoroughbred industry as well as other breed industries become more extensive, and more investment is put into the breeding of these horses, the value of the result (the foal) has increased as well. Eleven long months have been put into supporting and monitoring the dam, and ideally we give the foal the best possible chance at success. This is achieved by working closely with a veterinary professional and having a new foal exam performed within the first 12-24 hours and submitting bloodwork for white blood cell count (to ensure no infection) and an IgG. This demonstrates whether or not the foal has received an adequate amount of infection fighting antibodies from the dam’s colostrum, the first milk consumed that is essential for a healthy foal. The veterinarian can also identify subtle issues that can quickly escalate into larger problems and intervene before it becomes more severe and subsequently more expensive. It is essential that owner/veterinarian work together.
Q - What clinical exams are/should be performed by a vet in order to decide the exact care required for a problematic foal?
A - As mentioned before, the new foal exam is a routine physical examination performed by the veterinarian within the first 12-24 hours of birth. One of the most important aspects of this exam starts before I even enter the stall - I like to observe the foal and how it interacts with the mare. Is it nursing properly? Is it urinating and defecating properly without straining? Is it moving well in the stall getting up and down on its own?
The hands on exam is done systematically, looking at each body system (heart, lungs, eyes, gastrointestinal, musculoskeletal, neurologic) identifying any abnormalities associated with neonatal foals. Further examination and diagnostics will depend on the body system affected, but ultrasound, Radiograph and basic blood work is usually where I start to give myself a better idea of what may be happening. Results of all or parts of these examinations can better guide the veterinarian on how to proceed with further care, if any, for the newborn foal.
Q - How can an owner/breeder care for a sick foal, especially in the initial stages? What can be easily overlooked and taken into account?
A - Ability to care for a sick foal will depend on the owner’s experience and/or comfort level concerning monitoring and treating. Many owners/breeders are quite advanced in their ability to provide constant care and may not need to refer. Other factors include how sick the foal is - for many very sick foals, treatment at the farm is not practical, while other more mildly affected foals do well on farm care.
Initially, ideally the foaling is attended, and owners/breeders observe the foal in its first few hours of life- a foal should stand within the first two hours and nurse within three. If these things have not occurred within four hours, a veterinarian should be contacted.
One of the single most important things an owner can do when monitoring any neonatal foal is to take its temperature. By taking a newborn’s temperature twice a day every day for the first week of life or beyond, an owner can more efficiently alert their veterinarian. Normal temperature for a neonate is 99 degrees F (37.2 C)-102 F (38.9 C).
Making sure foals have a clean, safe, environment and being observant and diligent in their monitoring is a vital aspect of owning a foal. Increases in respiratory rate, subtle lameness, and behavior changes are other observations owners can make. Knowing normal makes it much easier to identify abnormal. If a veterinarian does determine that a foal is sick and requires treatment, many owners can perform basic medication administration. Each situation is different, and a good relationship with your veterinarian will help give your foal the optimum care in the first weeks of life.
Q - What are medical and nutritional requirements for orphan foals? How often do they face immunity issues?
A - In general, medical and nutritional requirements are the same for orphan foals as foals being raised by their dam. Unfortunately, birth is a dramatic event for a horse in which many things can go wrong for not only the foal but the mare as well. If there is no opportunity for a nursemare to be used, these foals must be tended to. The single most important factor for ensuring a healthy orphan foal is to provide adequate colostrum so that foal is provided with an adequate transfer of infection fighting maternal antibodies. If the mare dies shortly after birth, a foal will need to get this from another source. Here in Kentucky, we are fortunate to have a colostrum bank in which colostrum donated by other mares can be purchased. Where colostrum is not available, there are commercial colostrum supplements on the market, although these products are inferior to the real thing. If nothing is available, foal will require a plasma transfusion, a more expensive option . If this is not addressed early in an orphan foal’s life, it will most certainly struggle with immunity issues, facing potential problems such as sepsis (blood infection), infected joints, diarrhea and other complications.
Once an orphan has received adequate colostrum or plasma, it must be provided with an alternative to mare’s milk. Equine milk replacer or goat’s milk is best tolerated- calf milk replacer is not suitable. These foals need to be closely monitored for proper weight gain, and this can be a difficult balance.
Its also important that these foals are socialized- ideally with another orphan foal or older horse, but even sheep or goats have been used as successful companions.
Q - Can you tell us a bit more about the management of diarrheoic foals?
A - Diarrhea is one of the foremost issues of young foals and probably the most common “sick foal” call that I attend to on a daily basis. Diarrhea in neonatal foals should always be taken seriously, as it has the potential to be a medical emergency. Some diarrheas, such as “foal heat” diarrhea occurring around one week of age, can just be monitored without intervention. Other diarrheas, such as those caused by pathogens such as Rotavirus, Clostridium, and Salmonella, are emergencies, especially in the first week of life. In addition to IV fluids, these young foals are usually put on antibiotics. Other medications such as probiotics and gastroprotectants are also warranted. Older foals may not require fluids and IV antibiotics, but should still be monitored closely. Most of these foals can be managed on the farm with properly trained personnel, however some of the severely affected foals will need referral if possible.
Many of these are highly contagious, and can become a huge problem when an owner/breeder is faced with an outbreak situation. It is imperative that proper biosecurity protocols are in place to prevent this from occurring. With the exception of foal heat diarrhea, most neonatal foals with diarrhea should be examined by a veterinarian.
Q - Do you have horses of your own? Which are your favorite- Arabians or Thoroughbreds?
A - I own a 10 year old off the track Thoroughbred gelding that I literally saved from going to slaughter six years ago. Not really in the market for a horse at the time, I heard that this horse was given to a woman who was “going to find him a home” after his career at the track ended. Unknowingly, his owners gave him to this woman who was illegally selling them to another person taking them to slaughter. I had known this colt since birth, had done his new foal exam, nursed him through a bout of pneumonia as well as diarrhea as a foal, and finally followed him through a fracture sustained in a race requiring a plate and 15 screws. We nursed him back to health at the farm and he actually won a race post fracture repair, but was eventually retired. I couldn’t bear the thought of his life ending so undignified after everything he had been through, so we bought him back. He is kind and gentle with my children, and living the life of a king in central Kentucky.
I actually grew up owning and riding Arabians, and interned at an Arabian farm during college, so I will always hold a special place in my heart for them. My favorite horse of all time is an Arabian mare that I raised from 6 months old; she grew up with me and we were together through middle school, high school, college and vet school until I euthanized her a few years ago due to complications of laminitis. The Arabian breed is responsible for my passion for horses and in turn my interest in equine veterinary medicine.
Q - What if any temperamental or physiological differences do you see between Arabian or Thoroughbred foals who need neonatal care?
A - The main physiological difference in Arabians vs.Thoroughbreds are that there are congential abnormalities in Arabians that we look for that don’t exist in Thoroughbreds. Other than that, physiologically, we treat the foal as a foal, regardless of breed. Temperamentally however can be a different story. Someone in my childhood once said you “tell any other breed, but you ASK an Arab”, and I find this to be true with the foals as well. The vast majority of the foals I treat are Thoroughbreds, but when I do examine an Arabian I have great respect!
Rood & Riddle is a worldwide leader in equine healthcare offering innovative and highly skilled treatment of horses. Established in Lexington in 1982 as an ambulatory practice, Rood & Riddle became a full service equine hospital in 1986, serving as a referral center for horses requiring specialized medical and surgical care and providing ambulatory care for all breeds and disciplines. Rood & Riddle has recently expanded its Lexington, Ky location with the addition of a 208 acre reproduction facility. This addition, as well as satellite hospitals in Saratoga, NY and Wellington, FL, allows Rood & Riddle to uphold an unwavering commitment to quality, both in the care of horses and in relationships with clients and the community.