Equine Neonatal Septicemia

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Equine Neonatal Septicemia

By: Dr. Mary Rose Paradis

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Section: Treatment In-depth

Immunologic support. If a foal is older than 12 hours old, he may not be able to absorb the amount of colostrum needed to protect him from infection. Because of this the next best way to provide foals with antibodies is through a plasma transfusion. The amount of plasma necessary depends on the level of immunoglobulin present in the foal's blood. A foal with less than 200 mg/dl of immunoglobulin has received no colostrum and may required two or more units of equine plasma.

Antibiotic support. Antibiotics are used to help kill bacteria. Because you can't delay treatment until you identify the causative bacteria, your veterinarian will place the foal on an antibiotic or combination of antibiotics that will kill the majority of bacteria involved. A common combination of antibiotics used in septic foals is amikacin and penicillin/ampicillin. Most E. coli and Streptococcus infections are sensitive to this combination.

Shock treatment. Foals in shock have a lower blood pressure, which in turn causes decreased blood flow to the different organ systems. The kidneys are particularly affected. Intravenous fluids help to support their circulation. Foals less than 24 hours old often have a dangerously low blood sugar, and it is essential to correct this as soon as it is recognized by adding glucose to the fluids. The foal's blood may also become acidotic. Since there is a very narrow range of acidosis within which an animal can live, sodium bicarbonate can be added to the fluids to correct this abnormality.

Nutritional support. Septicemia and endotoxemia may cause foals to be anorexic. A foal needs between 6,000 and 8,000 kcals/day to support healing and growth. Because many sick foals will not or cannot suckle from their dam, your veterinarian will need to feed the foal through other methods, such as intubation or intravenous fluids. If the foal does not have diarrhea it is best to feed it with an indwelling tube from his nose to his stomach. For the first week of life the foal may need to be fed hourly or every other hour. Mare's milk or a commercial milk substitute can be used. If the foal has a gastrointestinal problem then intravenous feeding may be needed.

System Specific Therapy

Respiratory support. Septic foals with bacterial pneumonia have the lowest survival rate of all septic foals. Intensive respiratory physiotherapy is important in keeping the foal alive until the antibiotic and immunologic assistance has a chance to work. The amount of therapy depends on the severity of the respiratory compromise. It may consist of intranasal oxygen or mechanical ventilation.

Septic arthritis/osteomyelitis. Infection in or around a joint causes inflammation and joint swelling. The inflammation brings in enzymes that can destroy the cartilage that cushions that joint. It is important to tap into the joint fluid and flush the enzymes out to prevent further damage. Often this has to be done several times and may require anesthesia.

Meningitis. If the bacterial infection enters the central nervous system, the prognosis for survival is poor. Anticonvulsant drugs, such as Valium, maybe needed to control seizures. Antibiotic therapy would change to include an antibiotic that penetrates the meninges better that amikacin.

Eyes. Two different problems can be present in the eyes of the septic foal – uveitis and corneal ulceration. Uveitis is manifested as inflammation and/or pus in the front part of the eye. Corneal ulceration is usually secondary to the foal scratching his eye during his recumbency or from an inverting of the lower eyelid (entropion) when the foal is dehydrated and the eye ball sinks back into his socket. Treatment involves antibiotic and anti-inflammatory eye ointments and perhaps a small suture placement to correct the entropion.

Umbilical infections. Umbilical remnant infections that have been diagnosed by utlrasonography should be removed surgically as soon as the foal's condition is stable enough to permit surgery. The foal is anesthetized, and the umbilical structures are carefully dissected. Any areas of discoloration or swelling are removed and cultured.

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