OBJECTIVE:To evaluate severe hyponatraemia in foals presenting as medical emergencies to an intensive care unit (ICU) in order to determine the prevalence, clinical findings, primary diagnosis and outcome.DESIGN:Retrospective case study of records from Thoroughbred foals aged less than 3 months presenting to an ICU as medical emergencies in 2002-12; foals with severe hyponatraemia (serum sodium <122 mmol/L) on admission laboratory data were identified. Data retrieved included signalment, clinical findings, laboratory results, primary diagnosis, treatment and outcome.RESULTS:Severe hyponatraemia was identified in 69/1718 Thoroughbred foals (4%) presenting to the ICU during the study period. Of the 69 foals, 11 (15.9%) presented with neurological signs attributable to hyponatraemic encephalopathy and 7 of these foals had seizures; other neurological signs included obtundation, ataxia and apparent blindness. The three most common primary diagnoses of the 69 foals with severe hyponatraemia were renal disease (18/69, 26.1%), enterocolitis (16/69, 23.2%) and uroperitoneum (15/69, 21.7%). Treatment was directed at the primary disease and correction of the hyponatraemia. A total of 50 of the 69 foals (72.5%) with severe hyponatraemia survived to hospital discharge and 38 of them (76%) survived at least 12 months following discharge.CONCLUSION:The prevalence of severe hyponatraemia in this study population was 4%. The majority of foals with severe hyponatraemia did not demonstrate direct clinical manifestations as a result of the low serum sodium concentration. The outcome of foals with severe hyponatraemia was mostly favourable.

SummaryThis study investigated the immediate (6 h or less) effects of fibrinogen and albumin contained in transfused equine origin fresh frozen plasma on those proteins when measured in sick neonatal foals. Fibrinogen and albumin concentrations were measured in the administered plasma and in 31 sick foals at admission to a referral neonatal intensive care unit. Additional samples were obtained from the foals at 2 and 6 h following transfusion. No changes in albumin concentration were recognised. The main determinant of fibrinogen concentration following transfusion was the concentration of fibrinogen in the foal at admission. Importantly, intravenous transfusion of equine fresh frozen plasma did not result in immediate (6 h or less) increases or decreases in the fibrinogen concentration in the recipient foals. Fibrinogen from the donor contained within transfused plasma will not directly affect fibrinogen concentrations measured at later times.

Objective-To document causes of colic in equine neonates, evaluate clinical features of neonates managed medically versus surgically, determine short- and long-term survival rates for neonates with specific medical and surgical lesions, and assess ability of patients to achieve intended use.Design-Retrospective case series.Animals-137 client-owned equine neonates (<30 days old) with a history of colic or signs of colic within 1 hour after hospital admission examined between 2000 and 2010.Procedures-Signalment, history, results of physical examination, laboratory data, ancillary diagnostic tests, details of treatment, primary diagnosis, concurrent diseases and short-term survival rate were obtained from the medical records. Long-term follow-up information was obtained through phone survey.Results-137 neonates with colic were included. The majority (122 [89%]) of neonates were managed medically. The 3 most common diagnoses associated with colic were enterocolitis (37 [27%]), meconium-associated colic (27 [20%]), and transient medical colic (26 [19%]). The most common reason for surgery was small intestinal strangulating obstruction, and these neonates were more likely to have severe, continuous pain and were less responsive to analgesics. Concurrent diseases were common (87 [64%]) but did not significantly impact survival rate. Short-term survival rate was not significantly different between medically (75%) and surgically (73%) managed neonates. Long-term survival rate was excellent (66/71 [93%]) for horses that survived to hospital discharge. Most neonates surviving to maturity were used as intended (49/59 [83%]).Conclusions and Clinical Relevance-Most neonates examined for signs of colic can be managed medically. Short-term survival rate in medically and surgically treated neonates was good. Long-term survival rate of foals discharged from the hospital was excellent, with most achieving intended use.

SummaryCareful assessment of the biochemistry panel and familiarity with normal biochemistry values for neonatal foals is imperative in the workup of any critically ill neonate, particularly those with neurological signs. The importance of rapidity of change compared to the absolute value of the biochemical abnormality must be emphasised. Serial biochemical panels ideally assist in assessing rapidity of change. Many foals can have severe biochemical derangements in the absence of seizures. Identifying values that are significantly out of range should spur immediate therapy to correct them and potentially additional diagnostic testing to determine the cause of the abnormalities. A temporal relationship between correction of biochemical abnormalities and resolution of seizures and encephalopathic signs supports causation.

Colic in neonatal foals is common and unusual causes of colic are not rare. The case reported in this issue byTapioet 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.

REASONS FOR PERFORMING STUDY Recognising the presence of a necrotising component of the gastrointestinal disease may be clinically useful in ill equine neonates. OBJECTIVES To study the importance of abdominal sonograms in neonatal foals suffering from gastrointestinal conditions and to describe the clinical features of necrotising gastrointestinal disease. HYPOTHESIS There is a subgroup of neonates with sonographically detectable pneumatosis intestinalis (PI), reflecting a necrotising disease. METHODS Records of foals aged < or = 7 days hospitalised from 2005 to 2009 with signs of gastrointestinal disease were evaluated (n = 89). The association of sonographic, clinical and clinicopathological signs with necrotising gastrointestinal disease and outcome was determined. RESULTS PI was imaged in 19 foals. Twenty-seven foals were classified as having necrotising gastrointestinal disease based on the presence of gastrointestinal signs (colic, diarrhoea, gastric reflux or abdominal distension) and sonographic PI (n = 19), surgical (n = 2) or pathological (n = 6) evidence of gastrointestinal necrosis. There was a difference between survival rate in foals with and without necrotising disease (33.3 and 69.4%, respectively, P = 0.005) or foals with and without PI detected sonographically (36.8 and 72.1%, respectively, P = 0.023). PI was the only sonographic finding associated with outcome. Prematurity, the presence of blood in the faeces, gastric reflux, abdominal distension, abnormal echogenicity of the colon and the lowest white blood cell count during hospitalisation were associated with necrotising gastrointestinal disease (P < 0.05). CONCLUSIONS AND POTENTIAL RELEVANCE Abdominal sonograms have prognostic value in neonatal gastrointestinal disease. PI and the presence of necrotising gastrointestinal disease were common and associated with a poor prognosis.

BACKGROUND Lactate concentration in blood or plasma ([LAC]) and change in [LAC] are associated with survival in sick foals. HYPOTHESIS [LAC] and change in [LAC] over time are associated with survival at 96 hours and discharge in neonatal foals. Furthermore [LAC] and change in [LAC] over time correlate with blood culture results and blood pressure at admission. ANIMALS Two hundred and twenty-five foals consecutively admitted to a Neonatal Intensive Care Unit. METHODS Retrospective case review. Foals <or=30 days of age with [LAC] from arterial (190) or umbilical (35) blood gas analysis ([LAC](BG)) at admission, 24, and 48 hours. [LAC](BG), blood pressure, blood culture status, and outcome (survival versus nonsurvival at 96 hours and discharge) were recorded. Change in [LAC](BG) over time ([LAC](BG)DeltaT) was calculated. RESULTS [LAC](BG) was lower in survivors (96 hours and discharge) at all times. [LAC](BG)DeltaT was larger for survivors (96 hours). Odds of survival (96 hours and discharge) decreased 18, 39, 53 and 22, 38, and 47%, respectively, at each sample time for every 1 mmol/L increment in [LAC](BG) and increased 156% for each 1.0/day increment in [LAC](BG)DeltaT from admission to 24 hours at 96 hours. Blood pressure and [LAC](BG) were not correlated (P= .196) until removal of selected foals (mean arterial pressure <60 mmHg, admission [LAC](BG) <5.5 mmol/L) (P < .001). Bacteremia was not associated with [LAC](BG). Proposed admission [LAC](BG) cut-points for future studies were 6.5 mmol/L (96 hours) and 5.5 mmol/L (discharge). CONCLUSIONS AND CLINICAL IMPORTANCE Prospective studies evaluating [LAC], [LAC](BG)DeltaT, and cut-points in sick foals are warranted.

A 24‐hour‐old Welsh‐Thoroughbred foal presented for routine surgical repair of an abdominal and body wall hernia. The colt became acutely colicky and emergency celiotomy was performed revealing abnormal anatomical configuration of the gastrointestinal tract (GIT). Incomplete gastrointestinal rotation is a rare congenital anomaly only described in man. This report describes the clinical and diagnostic findings, surgical and medical treatment, and outcome of a neonatal foal with nonrotation of the GIT.

A 24-hour-old Welsh-Thoroughbred foal presented for routine surgical repair of an abdominal and body wall hernia. The colt became acutely colicky and emergency celiotomy was performed revealing abnormal anatomical configuration of the gastrointestinal tract (GIT). Incomplete gastrointestinal rotation is a rare congenital anomaly only described in man. This report describes the clinical and diagnostic findings, surgical and medical treatment, and outcome of a neonatal foal with nonrotation of the GIT.

OBJECTIVETo determine if changes in viscoelastic variables are associated with abnormalities observed in the standard coagulation profile and patient outcome in foals with suspected septicemia.DESIGNProspective clinical trial during 2003 and 2004 foal season.SETTINGNeonatal intensive care unit at a veterinary teaching hospital.ANIMALSThirty critically ill foals <72-hour-old admitted sequentially meeting criteria for systemic inflammatory response associated with infection.INTERVENTIONSHemostatic evaluation, using standard coagulation testing and viscoelastic analysis, was performed at admission, 24 hours following admission, and 48 hours following admission in critically ill foals. Standard coagulation tests included platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, fibrin(ogen) degradation products, and antithrombin. Data collected from viscoelastic analysis included time to initial clot formation (ACT), clot rate, and platelet function. Signalment, blood culture results, clinicopathologic data, and outcome were collected from medical records. Equality of populations test was used to determine associations between coagulation tests and blood culture status/outcome, as well as between viscoelastic parameters and coagulopathy, blood culture status, and outcome. Logistic regression was used to quantify associations. A significance level of P<0.05 was used.MEASUREMENTS AND MAIN RESULTSFoals with decreasing clot rate (CR) over the sample period were more likely to be euthanized or die (P=0.02). Foals with prolonged ACT (P=0.03), and decreased CR at admission (P=0.047), were more commonly coagulopathic. Identification of coagulopathy on admission (P=0.02), or persistence of hemostatic dysfunction 48 hours later (P=0.04), was associated with death.CONCLUSIONSViscoelastic coagulation evaluation could be used in a neonatal intensive care unit setting to further characterize coagulopathy, and identify foals at higher risk for poor outcome.

BACKGROUND:Coagulopathy is a potentially underrecognized complication of sepsis and septic shock in critically ill neonatal foals.HYPOTHESIS:Critically ill neonatal foals have abnormalities in coagulation that are associated with disease severity and outcome.ANIMALS:Foals <72 hours old admitted to a neonatal intensive care unit.METHODS:Prospective, observational study. Blood was collected at admission, 24, and 48 hours for platelet count, prothrombin time, activated partial thromboplastin time, antithrombin activity and concentrations of fibrin degradation products, and fibrinogen in plasma from all foals.RESULTS:Sixty-three foals were enrolled and classified as Septic Shock (12), Septic (28), and Other (23). At least 1 abnormal value was found in 18/28 (64%) samples from the Septic Shock group, 66/85 (78%) from the Septic group, and 30/59 (51%) from the Other group (P= .01). Coagulopathy (3 or more abnormal values) was present in 7/28 (25%) samples in the Septic Shock group, 14/85 (16%) samples in the Septic group, and 3/59 (5%) samples in the Other group (P= .0028). Clinically detectable bleeding occurred in 8/12 (67%) Septic Shock cases, 11/28 (39%) Septic cases, and 3/23 (13%) Other cases (P= .009). Foals in Septic Shock were 12.7 times more likely to have clinical evidence of bleeding than those in the Other group (95% CI 2.3-70, P= .004). Treatment with fluids or plasma did not have a detectable effect on coagulation values.CONCLUSIONS AND CLINICAL IMPORTANCE:Coagulopathy commonly occurs in critically ill neonatal foals, especially those with sepsis and septic shock.

The neonatal foal is in a period of transition between fetal and extrauterine life. The clinicopathologic findings in this period often reflect the in utero environment; thus, results need to be interpreted with the knowledge of changes that intrauterine life may produce. These changes can also assist the veterinarian in identifying a foal at high risk for developing clinical problems. The veterinarian should also be aware of the normal variations in clinicopathologic findings that occur as the foal matures. As with results from all diagnostic testing, the clinicopathologic results need to be interpreted with reference to the physical examination findings of the foal.

The aim of this study was to compare standard cardiopulmonary resuscitation (S-CPR) and diaphragmatic muscle cardiopulmonary resuscitation (D-CPR) for cardiac arrest (CA) in rabbit models. Twenty rabbits were randomized into either the S-CPR group or the D-CPR group. CA lasting 8 min was induced in healthy New Zealand rabbits through abdominal operation and tracheal tube clamping. During end-expiration 5 min after vital signs stabilized, the aortic pressure and transcutaneous oxygen saturation levels were recorded, and restoration of spontaneous circulation (ROSC) and the 6-h survival rate were analyzed. Five rabbits in the S-CPR group and eight in the D-CPR group achieved ROSC; the survival rate in the S-CPR group and the D-CPR group was 40% and 50%, respectively. Blood pressure indices in each group were higher post-ROSC than at baseline. One minute after resuscitation, the blood pressure values in the D-CPR group were higher than those in the S-CPR group (aortic systolic pressure=54.9 ± 10.1 mmHg versus 42.1 ± 16.2 mmHg, respectively; aortic diastolic pressure=22.1 ± 7.4 mmHg versus 15.1 ± 7.3 mmHg, respectively; mean arterial pressure=33.0 ± 5.8 mmHg versus 21.4 ± 8.5 mmHg, respectively; and coronary perfusion pressure=17.5 ± 7.5 mmHg versus 9.2 ± 6.6 mmHg, respectively). Five minutes after resuscitation, blood pressure values in the D-CPR group remained statistically higher than those in the S-CPR group. However, no differences between the two groups existed after 5 min. When compared to S-CPR, D-CPR resulted in a higher ROSC rate and a higher survival rate in rabbit models; however, the results depend on higher atrial pressure and cardiac output.

Objective-To review management of pregnant mares with body wall defects and assess the effect of various management strategies on the outcome of mares and their foals.Design-Retrospective case series.Animals-13 mares.Procedures-Medical records of eligible mares were reviewed. Signalment, history, admitting complaint, clinical findings, parity, type of body wall defect, concurrent diagnoses, postpartum complications, outcome of fetus, outcome of mare, and type of clinical case management were recorded.Results-8 mares received conservative management and 5 mares received interventional management. Survival of mares to discharge was good, and no difference in mare survival was identified on the basis of type of management, type of body wall defect, or presence of hydrops. Foal survival was significantly better in the conservative management group, compared with those managed by interventional management, and was also better without hydrops.Conclusions and Clinical Relevance-Foal survival can be improved in mares with body wall defects that occur during parturition without compromising mare survival by use of conservative management strategies that avoid induction of parturition or elective caesarian section and allow for natural parturition. Potentially, improved fetal readiness for birth may play a role.

BACKGROUNDBacteremia in sick foals is associated with survival, but the association of bacteremia and diarrhea is not reported.HYPOTHESISNeonatal foals with diarrhea will commonly be bacteremic.ANIMALSOne hundred and thirty-three neonatal foals.METHODSRecords of all foals <30 days of age presenting with diarrhea between January 1990 and September 2007 were reviewed.RESULTSSixty-six of 133 foals (50%) were bacteremic at admission, with 75 isolates from the 66 samples. The blood culture from a further 18 foals (13.5%) grew coryneform bacteria. Nine foals (6.8%) had 2 or more organisms grown on blood culture. One foal had 5 different organisms, interpreted as contamination. Forty-eight foals (36%) had no growth on admission blood cultures. No cultures isolated fungal organisms. Excluding coryneform bacteria, 43 isolates (57%) were Gram-negative organisms and 32 isolates (43%) were Gram-positive organisms. The most common isolate was Enterococcus spp. (22 isolates, 29%), followed by Pantoea agglomerans (13 isolates, 17%). IgG concentration at admission was not associated with blood culture status. Blood culture status was not associated with survival to hospital discharge.CONCLUSIONS AND CLINICAL IMPORTANCEBacteremia is common in neonatal foals with diarrhea. Decisions regarding antimicrobial selection should be made with these differences in mind.