Page 1367 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

1342 CHAPTER 14

VetBooks.ir 14.9 feeding and parenteral nutrition may be required
in many of these cases in order to maintain calorie
intake. In those cases where parenteral nutrition is
necessary it is important to encourage GI matura-
tion, and small trophic feeds of 5–10 ml/hour of milk
should be administered. Additionally, the use of glu-
tamine (10 g/day in divided doses) may help entero-
cyte repair and function.

Metabolic and cardiovascular support
Careful cardiovascular support is often required.
Intravenous fluids are frequently required to sup-
port the circulation, but volume overload can occur
quickly, and these foals are very intolerant of excess
quantities of sodium. Small amounts of mainte-
nance fluids (such as 5% dextrose) are often needed
Fig. 14.9 A septic dysmature foal undergoing critical
care with intravenous fluid therapy, enteral feeding but should be monitored closely. Some foals require
and intranasal oxygen. greater support with the use of inotropes or vaso-
pressors. Homeostatic mechanisms may be poorly
established and electrolyte concentrations should be
monitored regularly. Premature foals may be unable
Endocrine support to maintain body temperature, and this should be
The use of corticosteroids in the newborn remains monitored closely. They should be warmed, or the
controversial. The optimum dose and drug have environmental temperature increased as required.
not been established. Hydrocortisone can be given Premature foals can suffer ‘second day syndrome’:
at physiological doses (1.3 mg/kg/day divided into after 24 hours of improvement they slide irreversibly
4-hourly doses). Other suggested regimes include into hypotension, hypoxia, septic shock and multior-
a single 6 mg dose of betamethasone for a 50 kg gan dysfunction syndrome.
foal or dexamethasone at a dose of 0.02 mg/kg once
daily. Depot ACTH (0.5 mg/day for a 50 kg foal) has Immunological support
been suggested to enhance endogenous corticoste- Premature foals frequently fail to absorb adequate
roid production; however, it is unclear whether the quantities of colostral immunoglobulins and, when
immature adrenal gland is able to mount a response. this is combined with an immature immune system,
they are particularly susceptible to infection. The
Nutritional support use of broad-spectrum bactericidal antibiotics and
Premature foals may not tolerate enteral feeding intravenous hyperimmune plasma is helpful. The
owing to the immaturity of the gastrointestinal potential side-effects (e.g. nephrotoxicity) should be
(GI) tract. Enteral feeding should be used cautiously considered when selecting antibiotics for these foals.
and monitored closely. Colic, ileus and necrotis-
ing enteritis can result. Premature foals are often Respiratory support
in poor body condition and prone to hypoglycae- In some cases, humidified intranasal oxygen may
mia, and therefore the use of intravenous glucose be required. The foal should be maintained in the
and/or parenteral nutrition, plus careful blood glu- sternal position or regularly turned from side to
cose monitoring during assessment, is appropriate. side. If it can stand, it should be assisted in doing so.
Some foals are unable to regulate their blood glu- Arterial blood gas analysis can be useful to monitor
cose level and a continuous intravenous infusion of respiratory function. Failing respiratory function is a
insulin may be required. A combination of enteral poor prognostic sign. Mechanical ventilation may be