We are very happy to be sending home today, our first critical care foal of the season. He was born two weeks early and suffered from premature placental separation at birth. This in when the placenta comes out with the foal and results in oxygen deprivation or hypoxia. Initially the foal's mucous membranes were a terrible colour due to the lack of oxygen. He was comatose, with no suck reflex . Rae, one of our nurses , administered oxygen for the first hour and his colour started to improve. One of the problems with premature foals is that they haven't produced enough of a chemical called surfactant which is vital to allow full inflation of the lungs. This was clearly an issue with this case. To compound the foal's situation, his mother didn't have a drop of milk so no colostrum was available. Luckily the stud had another mare foal at the same time so we milked off some of her colostrum and fed it to the poorly foal via stomach tube. It was evident that this foal was going to require intensive care if he was to have any chance of survival so he was admitted to the Clinic with his mother. We started her on oxytocin and domperidone to stimulate milk production. The foal was fitted with a feeding tube so that milk could be given easily. We fed him every hour with 200ml of milk replacer, increasing to 300ml by day three. Luckily by day three, the domperidone had stimulated the mare’s milk production so that we could feed the foal the real stuff!

On day two of life the foal started showing the characteristic neurological signs of maladjustment, a delayed response to the oxygen deprivation at birth. This was treated with cortisone therapy and he was given the Madigan foal squeeze procedure which mimics the pressure on the torso normally experienced in the birth canal which is postulated to switch off certain neurosteroids which may keep the foal calm whilst still in the uterus. The intensive nursing was continued around the clock. The foal was also given intravenous fluid therapy to help maintain hydration and he was given two litres of hyperimmune plasma to provide the vital protective antibodies that were not obtained via colostrum. As neonatal foals are very susceptible to infection, broad spectrum intravenous antibiotics were administered throughout the foal's treatment. By day five, the foal showed significant improvement and with help, was able to stand. We held him under the mare and he very quickly started to suckle. By day seven, he was able to get up by himself and get onsuck. We left the feeding tube in place until we were satisfied that he was drinking sufficient milk on his own.

Another problem that we had to deal with was that the foal's urachus which connects the bladder to the umbilicus remained open after birth so that when he went to urinate, urine was coming out of his navel as well as his penis. Luckily we were able to resolve this with conservative treatment in the form of cauterising the naval with silver nitrate and placing a soft rubber ligature around the cord. Sometimes surgery is required to close the urachus.

So a big thank you to all our vets and nursing staff for a fantastic team effort to get this foal through a pretty tough start to life.