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How to Perform CPR on a Newborn Foal

 

How to Perform CPR on a Newborn FoalBegin administering chest compressions immediately to any foal born not breathing and without a heartbeat. Photo: SallyAnne L. Ness, DVM, Dipl. ACVIM

It’s bad news when a foal enters the world without taking a breath. But there’s some good news: Many foals born with beating heart and pulse, but who fail to breathe, can be revived via cardiopulmonary resuscitation (more commonly known as CPR). And there’s more good news: Both owners and veterinarians can perform CPR on a foal in need. The key is to be prepared in advance and not to wait until it’s too late to learn this potentially life-saving skill.

To that end, SallyAnne Ness, DVM, Dipl. ACVIM, reviewed how to perform CPR on newborn foals at the 2015 American Association of Equine Practitioners’ Convention, held Dec. 5-9 in Las Vegas, Nevada. Ness is an internal medicine specialist at Cornell University’s College of Veterinary Medicine, in Ithaca, New York.

Be Prepared

Ness said many veterinary clinics keep portable neonatal crash kits prepared and handy. These kits should contain the products needed to deliver life-saving oxygen to foals that fail to breath upon delivery.

She also recommended that veterinarians have on hand the injectable medications that can aid resuscitation when a foal’s heart rate gets too low or stops beating—epinephrine (adrenaline) and vasopressin (a hormone that raises blood pressure and helps maintain blood flow to the heart and brain). She also suggested printing a dosing chart ahead of time to prevent errors if medications are drawn up and administered in a hurry.

When the Foal Arrives

Ness said veterinarians and foaling attendants should rapidly assess any foal that fails to move and/or breathe upon delivery. She recommended:

  • Placing him in a sternal position (on his abdomen with tucked-under legs) and clearing the airways;
  • Identifying any rib fractures and/or congenital deficits;
  • Auscultating (listening with a stethoscope) the lungs and heart; a healthy foal’s respiration rate should be 20 to 40 breaths per minute and pulse should be 60 to 80 beats per minute, she said;
  • Palpating for pulses; and
  • Clamping the umbilicus.

This assessment should take less than a minute. She suggested giving several people specific jobs—one team leader, one to listen to the heart and lungs, etc. She also said attendants should be prepared well in advance for high-risk pregnancies or foalings.

The foaling team’s job is easy if the neonate’s heart is beating and he’s breathing properly. If he’s not breathing, however, it’s time for them to begin attempting resuscitation.

First, rub and dry the foal, she said. Sometimes tactile stimulation helps prompt the foal to breathe. Poking the muzzle and nostrils with straw can also incite a reflex that prompts the foal to take a breath. If he isn’t breathing after 10 to 15 seconds, he’ll need ventilation.

Ness said intubation is the easiest option and can be approached either through the foal’s nasal passages or his mouth. In this instance, the veterinarian will extend the foal’s neck and pass an endotracheal tube into the trachea. Then, he or she will inflate a cuff to seal the tube within the trachea and connect an Ambu Bag, which allows the veterinarian to administer breaths to the foal.

Alternatively, veterinarians and foaling attendants can use a non-intubated approach. Ness said in this case, the attendant can use a mouth-to-nose approach. To do this, Ness instructed, “You block the lower nostril (the one closest to the ground as the foal lies) with your hand and blow into the upper nostril.” Another non-intubated option is a mask with a self-inflating air pump made specifically for foals. This last option is probably the easiest and safest choice for foaling attendants and nonveterinarians, she added.

Regardless of which option the veterinarian or attendant uses, Ness said the goal is to apply 10 breaths per minute, holding the first inspiration for three to five seconds and then using quick, short breaths after that. She recommended reassessing the foal after 30 to 60 seconds.

Handling Foals Without a Heartbeat

“A foal born not breathing and without a heartbeat for any length of time is unlikely to respond to CPR,” Ness said. “But you have nothing to lose doing CPR on a dead foal. It’s doing something instead of nothing. Some can come back if the arrest began right at birth.”

She recommended beginning chest compressions immediately. The veterinarian should maintain a straight back and locked elbows and place one hand on the other on the widest part of the foal’s chest wall. Then, using his back and core muscles, begin applying 100 to 120 compressions per minute, aiming to compress the chest by one-third with each compressions. Ness noted that an easy way to get an appropriate compression rhythm is by mentally singing Stayin’ Alive by the Bee Gees and compressing along with the beat. Ironically, she laughed, Another One Bites The Dust by Queen has a similar beat and could also be used to achieve an appropriate compression rhythm. She recommended having the foaling team take turns performing compressions in two-minute cycles to prevent fatigue.

Ness said the foal should receive 30 compressions for every two breaths. If the animal is intubated, she said the compressor doesn’t need to stop. If he’s not intubated, the compressor should stop every 30 seconds so breaths can be administered. Additionally, veterinarians can administer epinephrine every four minutes to aid in revival, she said.

When to Stop

Ness recommended continuing CPR until the foal is breathing on his own and has a heart rate over 60 beats per minute. She recommended that foals that do respond positively should still be monitored closely for relapse.

She noted that if a foal fails to respond after 15 minutes, success is unlikely.

Take-Home Message

Knowing CPR and being prepared in advance to administer it to foals in need is essential for both veterinarians and foaling attendants.

“CPR is a rewarding and life-saving procedure that can result in a positive outcome when delivered quickly and with proper technique,” Ness relayed.

ABOUT THE AUTHOR

Erica Larson, News Editor

Erica Larson, news editor, holds a degree in journalism with an external specialty in equine science from Michigan State University in East Lansing. A Massachusetts native, she grew up in the saddle and has dabbled in a variety of disciplines including foxhunting, saddle seat, and mounted games. Currently, Erica competes in eventing with her OTTB, Dorado.

How to Predict When a Mare Will Foal

How to Predict When a Mare Will Foal Most deliveries transpire smoothly with no ill effects. But when a problem does occur—even a simple issue such as an easily correctable dystocia (difficult birth)—things can go south rapidly.

For some breeders, the waiting game starts as soon as the mare is inseminated. For others, it starts when she’s confirmed in foal. Still for others, it starts when she her belly grows large. Whenever that waiting game starts, all breeders want to know: When will my mare foal?

Igor Canisso, DVM, MSc, PhD, Dipl. ACT, Dipl. ECAR, previously of the University of Kentucky Gluck Equine Research Center and now an assistant professor of equine theriogenology at the University of Illinois College of Veterinary Medicine, offered some tips on how to predict when a mare will foal.

Most deliveries transpire smoothly with no ill effects. But when a problem does occur—even a simple issue such as an easily correctable dystocia (difficult birth)—things can go south rapidly, Canisso said. Additionally, “in certain situations, we don’t want let the foal suckle on its dam due to risk of developing a condition such as neonatal isoerythrolysis,” or acute hemolytic anemia caused by ingesting antibodies in the mare’s colostrum and milk that are directed against the neonate’s red blood cells, he said.

“That’s why each foaling should be attended,” he explained. “If there is a simple problem, it can easily be corrected by an experienced foaling attendant. Or, if there is a more serious condition, the mare can be referred to a clinic, or a veterinarian can be called to check the mare.

“Usually, it is best not to wait (to call the veterinarian), as after 30 minutes from ‘water break,’ every 10-minute delay in foaling decreases the foal’s survival rate by 10%,” Canisso said.

And because the vast majority of foalings take place between 6 p.m. and 6 a.m., he said, it’s important to know when you might want to start brewing coffee for overnight foal watches.

Here are some of the options owners and veterinarians can use to predict when a mare will foal.

Estimated Foaling Date—The average equine gestation length is between 335 and 345 days. So you should be able to easily calculate your mare’s estimated foaling date if you know when she was bred. For example, if your mare was bred on Feb. 10 and has an average gestation, you can tentatively expect a foal between Jan. 12 and Jan. 22 of the following year. Canisso cautioned, however, that gestation length varies substantially between breeds, time of the year (it’s usually longer when the mare is due to foal in the late winter and early spring), and individual mares, so use this method only as a guide.

If you’re unsure of when your mare was bred, your veterinarian can perform an ultrasound exam to estimate the mare’s stage of pregnancy and calculate an estimated foaling date.

Physical Signs—As the mare’s due date approaches, start watching for physical signs indicating she’s preparing to foal, including:

  • Tailhead relaxation—Canisso noted this is harder to identify in overweight, heavily muscled, or maiden mares;
  • Vulva relaxation and elongation—Canisso cautioned that some older mares might have very pronounced vulvar relaxation well before foaling while others mares will show minimal or no appreciable changes, so don’t rely solely on this factor to predict foaling; and
  • Mammary gland enlargement—Canisso said most mares’ mammary glands will begin getting larger about a month before their due date, with the most notable changes in the last two weeks prior to foaling. Maiden mares might not show substantial udder enlargement until close to parturition, he said.

Canisso cautioned that maiden mares might not display the same physical signs as seasoned broodmares.

Mammary Gland Secretions—For the last three decades many veterinarians and breeders have used mares’ mammary gland secretion electrolyte levels to predict foaling. In the normal mare, the mammary gland secretion’s calcium and potassium levels rise while sodium decreases closer to foaling. However, measuring these electrolytes to predict foaling requires a machine to analyze the levels and serial measurements. Canisso said that, commonly, breeders and veterinarians have submitted these electrolyte samples to a laboratory, which can be expensive and prohibit the practice’s use for mares not located close to a laboratory–essentially, most mares in most regions.

Because calcium is the most reliable and commonly used electrolyte, commercial kits are now available for breeders to use to estimate the mammary secretions’ calcium carbonate content and, thus, help predict when the mare will or will not foal. The commercial calcium carbonate test’s limitations include the costs and required dilutions to obtain an accurate reading, said Canisso.

Recently, Canisso and colleagues tested another method by which to predict foaling using mammary gland secretions. This time, however, they measured the secretions’ pH levels. Using commercially available pH test strips, owners can test the mammary gland secretions once daily; when the normally slightly basic secretions (pH> 8) drop to below 7 on the pH scale, the mare will likely foal within 24 hours, Canisso said. In his recent study, 11 of 14 mares foaled within 24 hours when their mammary gland secretion pH levels were 7 or lower; the remaining three study mares foaled without significant pH changes, he said.

In the same study, Canisso and colleagues compared the secretions’ pH levels with their calcium, sodium, and potassium concentrations. They found that the pH measurements were equally as effective as electrolyte measurements at predicting foaling, suggesting that pH can replace electrolyte measurements, he said. Canisso also noted that measuring pH is advantageous over electrolytes because the tests cost less; are more practical, as no dilutions are needed to determine pH; and require only a small drop of secretion to complete—this is especially beneficial for maiden mares, he said, as many maiden mares have a very small amount of pre-foaling mammary gland secretions, making electrolyte measurement very difficult.

Electronic Devices—Next, Canisso described some electronic devices breeders can use to alert them to impending foaling:

  • The Foal-Alert is a magnetic device that a veterinarian sews into the mare’s vulva. When the magnets are separated as the vulva expands during foaling, an alert is sent to a pager or cell phone, or an alarm sounds in the barn. Canisso said while this device can be used successfully, it can also cause many false alarms. Additionally, the alarm might not sound if the foal is malpositioned in the uterus or if its feet don’t penetrate the mare’s vulva.
  • The Breeders’ Alert is a position-monitoring device shaped like a small box that attaches to the mare’s halter and sounds an alarm when it detects that the mare is in lateral recumbency (the position in which they deliver a foal) for more than 15 seconds. Like the Foal-Alert, Canisso said, this device causes a lot of false alarms.
  • The last device Canisso described is the Birth Alarm. Like the Breeders’ Alert, the Birth Alarm monitors a mare’s position; however this device is located on a surcingle. When the mare lies down for more than about 8 seconds, an alert is sent to the individual monitoring the mare. As with the other two devices, Canisso said this can throw false positives, and it might be cost-prohibitive for some breeders.

Video Monitoring Systems—Finally, Canisso noted that many breeders and veterinarians employ video monitoring systems that allow them to keep an eye on the mare for signs of foaling from afar.

So which method should breeders select? Canisso said many breeders opt for a combination of the available options to give themselves the best chance to accurately predict when a mare will foal.

“Since there isn’t a single and perfect way to predict foaling in all mares, the best approach is to combine different strategies to maximize the results,” he said.

ABOUT THE AUTHOR

Erica Larson, News Editor

Erica Larson, news editor, holds a degree in journalism with an external specialty in equine science from Michigan State University in East Lansing. A Massachusetts native, she grew up in the saddle and has dabbled in a variety of disciplines including foxhunting, saddle seat, and mounted games. Currently, Erica competes in eventing with her OTTB, Dorado.

Preparing Mares for Foaling

Preparing Mares for FoalingA mare’s teats will become waxy around one to four days before foaling, and sometimes sooner. Photo: Courtesy of Dr. Ben Espy

The end of one year and the beginning of another is an exciting time for many breeders, as it likely marks the last trimester of their mares’ pregnancies. Due to the rapid changes that occur in the last few months of gestation, it is imperative that owners monitor mares closely. Udder development, abdominal distension, and presence of vaginal secretions are some of the most important changes to monitor. 

Average gestational length is around 11 months and a week, or 335 to 342 days. However, sometimes the duration is shorter or longer (330 to 360 days or more) with no detrimental effects on the fetus or mare.  

Remove mares from endophyte-contaminated tall fescue pastures no later than 10 months of gestation to prevent abnormal prolonged pregnancy, decreased milk production, and even abortion, and work with your veterinarian to determine whether a mare needs to be medicated with a prolactin stimulation product to negate the endophyte’s effects. 

Lack of udder development four to six weeks before foaling in a mare that is not grazing tall fescue or is not on pergolide medication for equine Cushing’s disease should not be a cause for alarm. Normal udder development starts in the month prior to delivery. Typically, the udder becomes engorged within the last few days before foaling (parturition). Waxy accumulation at the nipples from early colostrum (the mare’s antibody-rich first milk) production occurs one to four days before foaling but sometimes earlier. Occasionally, milk leaks from teats for several days to weeks before foaling, resulting in colostrum loss. If this occurs, work with your veterinarian to find an alternative source of colostrum for the neonate before foaling.

Take premature lactation (a clinical sign of placentitis) seriously and have your veterinarian examine the mare’s uteroplacental thickness (abnormal thickness can indicate issues such as placentitis). At the same time he or she should perform a vaginal exam and make sure no vaginal discharge is visible until a few days before delivery. Although abdominal distention is normal and more noticeable in the last trimester, have sudden and excessive distention evaluated to rule out hydrops conditions (excess placental fluids) or excessive edema (fluid swelling) that can weaken the ventral abdominal musculature. 

By the tenth month of gestation, the fetus will no longer be able to turn around. At this time mares can be examined using rectal ultrasound to determine fetal presentation. Although we can’t predict complications such as dystocia (a difficult birth), we can determine if the foal’s head is facing the cervix properly (anterior presentation). If the veterinarian can’t visualize the foal’s eyeball through the rectal wall on an ultrasound exam, this could indicate a possible breech (posterior presentation). Additionally, the veterinarian can evaluate uteroplacental thickness, examine the vulva for signs of discharge, and open the vulva if the mare had ever undergone a Caslick’s operation (sutures to prevent reproductive tract contamination). The veterinarian should also boost the mare’s immune system by administering her 10-month vaccinations; this will help her produce antibodies that will ultimately pass through the colostrum to the newborn in the first few hours after birth. The vaccines given will depend on the mare’s geographic location and her risk of disease exposure. Owners should move mares to a foaling facility, if necessary, at this time. 

During the final two weeks before her due date, the veterinarian should examine the mare frequently for physical changes such as vulvar laxity and edema, mucoid (resembling mucus) vulvar discharge, broad ligament (which suspends the uterus in the abdomen) relaxation, and udder size and secretion. Predicting the exact time of parturition is challenging, particularly in first-time foaling mares. The vet can, however, measure calcium and magnesium levels in udder secretions, which will increase in the last two to four days before parturition, to predict the time of foaling.

The actual foaling process is short and explosive, with delivery usually occurring in 20 to 30 minutes. If labor progression is slow, or if delivery lasts longer, the veterinarian should assess the mare immediately and correct any foal positioning abnormalities if necessary.

ABOUT THE AUTHOR

Juan Samper, DVM, MSc, PhD, Dipl. ACT

Juan C. Samper, DVM, MSc, PhD, Dipl. ACT, practices in British Columbia specializing in reproduction.

Foaling Horses: 101 to 911

Foaling Horses: 101 to 911

Keep a close eye on your newborn foal, his vitals, and his environment, and always get veterinary assistance if something goes wrong. When in doubt, ask your veterinarian, and never take “wait and see” approach. Photo: Anne M. Eberhardt/The Horse

During and after foaling are two of the most critical times in a neonate and his mother’s lives. One little thing gone wrong could set off a potentially life-threatening cascade of events for either horse. Rissa Parker, BVSc Pret, from Glen Austin Equine Clinic, in Gauteng, South Africa, has had a special interest in mare and foal care for the past 24 years and shared her first-hand knowledge of how to identify normal vs. emergency situations with attendees at the 2014 Cape Breeders Club Seminar, held Jan. 27-28, in Stellenbosch, South Africa.

Parker first described the three stages of foaling:

Stage 1 begins when the foal starts to position itself for birth within the mare’s womb. Parker said signs of this first stage of impending parturition in the mare include restlessness, kicking at the abdomen, lifting the tail, sweating, urinating, and rolling as if colicking. While these signs might be distressing to an owner, Parker said there’s nothing to fear unless they carry on for more than an hour. At this point, consider it an emergency and call your veterinarian immediately.

Stage 2 is the presentation of the foal. At this time the mare’s water breaks, and she delivers the foal. This stage occurs rapidly, said Parker—within about 10 to 30 minutes. Consider anything longer to be an emergency requiring veterinary attention, Parker said. After 30 minutes, “for every 10 minutes that go by, there’s 10% less chance of the foal surviving,” she noted.

If everything progresses smoothly, however, Parker advised owners to clear the foal’s nasal passages and then sit back and watch. The foal’s umbilical cord should break spontaneously as he becomes active. “Do not cut it,” Parker urged. “This can cause bleeding and infection.” Any bleeding from the umbilical cord is an emergency, she said.

If the cord breaks properly on its own, treat it with a chlorhexidine-alcohol spray three times a day for two days, then two times a day for two more days, Parker said. Any hemorrhaging, patent urachus (urine dripping through the umbilicus), or edema (fluid swelling) in the umbilical region warrants a quick call to your veterinarian.

If you observe discoloration of the placental surface (seen here) or holes in the placenta, call your veterinarian right away.Photo: Courtesy Dr. Rissa Parker

 

Stage 3 includes the passing of the placenta from the mare. This typically lasts one to three hours, but if it continues any longer, consider it an emergency. With a slow-to-pass placenta, Parker suggested administering oxytocin to help it “let go.” But do not, however, try to pull the placenta out yourself. “This can leave minute amounts of villi (the small, vascular projections that attach the placenta to the endometrium) still in the uterus,” Parker warned. If the placenta does not pass or a piece of it remains in the mare, she can develop endometritis (uterine infection).

If the placenta passes without problem, examine its horns and body thoroughly to ensure the horn tips are intact and that its weight, color, and integrity are normal. If you observe discoloration of the placental surface or holes in the placenta, call your veterinarian right away.

“The placenta reflects the uterine environment the foal was in,” Parker said. It should weigh less than 11% of the foal’s body weight—any more than that might indicate edema or other problems; these high-risk foals require blood tests and monitoring to ensure they are not septic or compromised and to tackle the problem early.

Examine the amnion for signs of inflammation before discarding it. Photo: Courtesy Dr. Rissa Parker

Parker added that some owners throw away the amnion (placental membrane) without checking it first, but said it’s important to examine this part for amnionitis (inflammation of the amnion which occurs in certain disease syndromes resulting in fetal losses).

Post-Partum

After parturition, Parker said it’s very important to allow the mare and foal to bond. But first, wash the mare’s udder and legs as soon as possible. Foals have a tendency to suckle on anything they can while learning to nurse, and they can easily pick up any bacteria on the mare. After this, just sit back and observe, Parker said. Watch that the foal is breathing, that he attempts to stand within one hour, and that he nurses within about three hours (any longer than this is a cause for concern).

“The foal must drink within four to six hours,” she explained. “Suckling aids gut motility as well as colostrum (the mare’s antibody-rich first milk) absorption.”

Although it might seem like an obvious task, she emphasized the importance of watching the foal nurse. Horses have a natural fight or flight instinct; for a foal this often manifests as cowering with his head under the mare’s belly. Parker said at first glance, it might appear as if the foal is nursing, when in reality he’s not. To determine whether he is truly getting milk, check the fullness of the mare’s udder (if it’s very full, he’s probably not drinking), and seek veterinary assistance if needed.

Foals that don’t consume enough good-quality colostrum (seen here) are at risk of failure of passive transfer. Photo: Courtesy Dr. Rissa Parker

Why is it so important the foal suckles? Because if he doesn’t consume enough colostrum from his mother’s first milk, he is at risk of failure of passive transfer (FPT), said Parker. To determine whether your foal has achieved passive transfer, have your veterinarian measure his IgG antibody levels within the first 24 hours of life. More than 800mg/dl is adequate; 400-800 mg/dl is partial FPT; and less than 200 mg/dl is complete FPT. Parker said she typically treats foals with FPT with a plasma transfusion and antimicrobial administration if the foal shows signs of sepsis.

Signs of Trouble

Parker also described signs to look for in the foal that might indicate a problem needing veterinary attention. First, know how to recognize normal foal vital signs, including:

  • Temperature between 38-38.9°C (100.4-102.02°F);
  • Heart rate 40-80 beats per minute (bpm) initially, increasing to 130/150 bpm in the first week and then decreasing to 60-80 bpm after that; and
  • Respiratory rate greater than 60 breaths per minute during the first hour, decreasing to 20-40 breaths per minute after the first one to two hours.

Once you have these core measurements down, look for signs of the following common neonate issues:

  • Meconium impaction Clinical signs of an impaction of these first feces include straining, bloating, colic signs, and an absence of suckling. “If the foal is bloating, take him off the mare so you are not filling up a dysfunctional gut,” Parker said. She said her typical treatment includes a noncommercial enema using an acetylcysteine base (which breaks down the disulfide bonds that make the meconium so hard and sticky) and warm water for 20 minutes under sedation.
  • Ruptured bladder Because this condition can be life-threatening, make sure your newborn foal urinates a full stream, keeping in mind that the bladder might not even become full for two to three days. “Foals with ruptured bladders show signs of abdominal distension and anuria (the absence of urination),” Parker said. Transport affected foals to a surgical facility for correction.
  • Diarrhea Although common in foals, veterinarians don’t always know what causes diarrhea, Parker said. This is yet another reason why it’s so important for owners and breeders to stand back and observe the neonate, taking into account his age, vitals, habitus (when the foal is quiet, such as eating or sleeping), and drinking/hydration. Diarrhea causes can be infectious (e.g., from viruses such as corona or bacteria such as Escherichia coli or Rhodococcus equi), noninfectious (e.g., due to overfeeding, lactose intolerance, pica [consuming nonfood items]); or parasite-related (Strongyloides westerii).

    Parker cautioned that, when it comes to infectious diarrhea-causing agents, “we underestimate how much we can transmit disease ourselves. It’s good practice to have a box of disposable gloves at your farm for handling newborns.”

    Diarrhea treatment includes resting the foal’s gut by withholding milk, but not water, for 24 hours. Your veterinarian might then recommend feeding 50 ml of milk every 4 hours to feed the enterocyte cells that line the horse’s gut, administering Bio-Sponge (Di-tri-octahedral smectite) to line the gut, and feeding the foal salt (1 tsp twice daily) to replace lost sodium.

    “If the foal isn’t suckling or has a high temperature, it’s an emergency that requires veterinary attention which may then include antimicrobial administration and intravenous fluids,” Parker said. “Sequelae to diarrhea include lactose intolerance, patent urachus, and joint ill (infection), so you’re not completely out of the woods (after diarrhea subsides).”

  • Musculoskeletal issues Foals can be born or acquire conditions such as congenital limb deformities and lameness due to infected joints or limb injuries, all of which require veterinary attention. So pay close attention to your newborn’s lower limbs as well.

Take-Home Message

Keep a close eye on your newborn foal, his vitals, and his environment, and always get veterinary assistance if something goes wrong. When in doubt, ask your veterinarian, and never take “wait and see” approach—it could be the difference between life and death for your foal.

ABOUT THE AUTHOR

Alexandra Beckstett, The Horse Managing Editor

Alexandra Beckstett, Managing Editor of The Horse and a native of Houston, Texas, is a lifelong horse owner who has shown successfully on the national hunter/jumper circuit and dabbled in hunter breeding. After graduating from Duke University, she joined Blood-Horse Publications as Assistant Editor of its book division, Eclipse Press, before joining The Horse.

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