Neonatal Diseases of Foals Neonatal Diseases of Foals Jon Palmer Jon Palmer New Bolton Center New Bolton Center School of Veterinary Medicine School of Veterinary Medicine University of Pennsylvania University of Pennsylvania
Neonatal Diseases Neonatal Diseases Neonatal Encephalopathy Neonatal Encephalopathy Neonatal Nephropathy Neonatal Nephropathy Neonatal Gastroenteropathy Neonatal Gastroenteropathy Sepsis/septic shock Sepsis/septic shock Prematurity Prematurity IUGR IUGR
Neonatal Encephalopathy Neonatal Encephalopathy Neonatal Maladjustment Neonatal Maladjustment Syndrome (NMS) Syndrome (NMS) “Dummy foal” “Dummy foal” Barkers Barkers Hypoxic Ischemic Hypoxic Ischemic Encephalopathy (HIE) Encephalopathy (HIE)
Neonatal Encephalopathy Neonatal Encephalopathy Changes in behavior Changes in behavior Changes in responsiveness Changes in responsiveness Changes in muscle tone Changes in muscle tone Brain stem damage Brain stem damage Seizure Seizure- -like behavior like behavior
Neonatal Encephalopathy Neonatal Encephalopathy Changes in behavior Changes in behavior Loss of suckle response Loss of suckle response Loss of tongue curl Loss of tongue curl Loss of tongue coordination Loss of tongue coordination Disorientation especially relative to the udder Disorientation especially relative to the udder Aimless wandering Aimless wandering Blindness Blindness Loss of affinity for the dam Loss of affinity for the dam Abnormal vocalization ("barker") Abnormal vocalization ("barker")
Changes in behavior Changes in behavior
Changes in behavior Changes in behavior
Neonatal Neonatal Encephalopathy Encephalopathy Changes in responsiveness Changes in responsiveness Hyperesthesia Hyperesthesia Hyperresponsiveness Hyperresponsiveness Hyperexcitability Hyperexcitability Hyporesponsiveness Hyporesponsiveness Periods of somnolence Periods of somnolence Unresponsiveness Unresponsiveness Changes in muscle tone Changes in muscle tone Extensor tonus Extensor tonus Hypotonia Hypotonia Neurogenic myotonia Neurogenic myotonia Failure to protract legs Failure to protract legs
Neonatal Encephalopathy Neonatal Encephalopathy Signs of Brain Stem Damage Signs of Brain Stem Damage Changes in respiratory patterns Changes in respiratory patterns Tachypnea, apneusis Tachypnea, apneusis Apnea, cluster breathing Apnea, cluster breathing Central hypercapnia Central hypercapnia Loss of thermoregulation Loss of thermoregulation Weakness Weakness Hypotension Hypotension Vestibular signs Vestibular signs Facial nerve paresis Facial nerve paresis Loss of consciousness Loss of consciousness
Neonatal Encephalopathy Neonatal Encephalopathy Seizure- -like behavior like behavior Seizure
Neonatal Nephropathy Neonatal Nephropathy Spectrum of disease Spectrum of disease Incomplete fetal transition Incomplete fetal transition Water/Na retention Water/Na retention Mild tubular dysfunction Mild tubular dysfunction Acute tubular necrosis Acute tubular necrosis Usually transient Usually transient Occasionally Occasionally Irreversible acute damage Irreversible acute damage Chronic renal disease Chronic renal disease
Neonatal Nephropathy Neonatal Nephropathy Decreased GFR Decreased GFR Slow decrease birth Cr Slow decrease birth Cr Decrease Decrease Cl Cl cr cr Decreased H Decreased H 2 O excretion 2 O excretion Edema formation Edema formation Weight gain Weight gain Slow response to fluid challenges Slow response to fluid challenges
Neonatal Nephropathy Neonatal Nephropathy Abnormal electrolyte handling Abnormal electrolyte handling Na loss Na loss Abnormal Na balance Abnormal Na balance Abnormal excretion of drugs Abnormal excretion of drugs High amikacin trough levels High amikacin trough levels Oliguria/Anuria Oliguria/Anuria
Neonatal Gastroenteropathy Neonatal Gastroenteropathy Wide spectrum of disease Wide spectrum of disease Mild indigestion Mild indigestion – – functional deficits functional deficits Dysmotility Dysmotility Enema dependence Enema dependence Moderate disease Moderate disease Colic Colic Abdominal distension/ileus Abdominal distension/ileus Diapedesis of blood into the lumen Diapedesis of blood into the lumen Mucosal edema Mucosal edema
Neonatal Gastroenteropathy Neonatal Gastroenteropathy Severe Severe Epithelial necrosis Epithelial necrosis Intussusceptions Intussusceptions Structures Structures Hemorrhagic gastritis or enteritis/colitis Hemorrhagic gastritis or enteritis/colitis Pneumatosis intestinalis Pneumatosis intestinalis Predisposition to sepsis Predisposition to sepsis Translocation of bacteria Translocation of bacteria
Neonatal Gastroenteropathy Neonatal Gastroenteropathy
Neonatal Gastroenteropathy Neonatal Gastroenteropathy
Neonatal Gastroenteropathy Neonatal Gastroenteropathy
Neonatal Multisystem Neonatal Multisystem Maladaptation Syndrome Maladaptation Syndrome Neonatal Encephalopathy Neonatal Encephalopathy Neonatal Nephropathy Neonatal Nephropathy Neonatal Gastroenteropathy Neonatal Gastroenteropathy Neonatal Metabolic Maladaptation Neonatal Metabolic Maladaptation Neonatal Cardiovascular Maladaptation Neonatal Cardiovascular Maladaptation Neonatal Neonatal Autonomic Autonomic Maladaptation Maladaptation Neonatal Neonatal Endocrine Endocrine Maladaptation Maladaptation
Neonatal Multisystem Maladaptation Syndrome Neonatal Multisystem Maladaptation Syndrome Prognosis Prognosis 85 85- -87% of foals with uncomplicated courses 87% of foals with uncomplicated courses recover completely recover completely
Prematurity Prematurity Dysmaturity Dysmaturity IUGR IUGR
Terminology Terminology Prematurity Prematurity < 320 days < 320 days Dysmaturity Dysmaturity > 320 days > 320 days Looks premature Looks premature Prematurity Prematurity Not by calendar Not by calendar Relative to mare’s normal gestation Relative to mare’s normal gestation Clinical appearance Clinical appearance IUGR IUGR Clinical characteristics Clinical characteristics May accompany prematurity May accompany prematurity Precocious development Precocious development
Sepsis/Infections Sepsis/Infections Definitions Definitions Clinical diagnosis Clinical diagnosis 1991, 2001 1991, 2001 Consensus Conferences Infection Infection Bacteremia Bacteremia Pulmonary Pulmonary GIt GIt Umbilical Umbilical SIRS SIRS Sepsis Sepsis Severe Sepsis Severe Sepsis Septic shock Septic shock
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