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Success Story of the Month: Septic Foal Care

Published: November 6th, 2012

Category: Neonatal ICU, News, Success Story

An Observant Horse Owner

Zara less than one hour after birth

Arabian owner and enthusiast, Laura Causey, was with her 10 year-old mare, Blissful Bey, the night the mare gave birth to Plumwoods Zara. Laura is an experienced Arabian owner who could tell the difference between a healthy foal and a foal that required additional support. She knew that newborn foals needed to be continuously observed because changes can happen in an instant.

Zara’s birthing process went flawlessly. Laura knew the 1-2-3 rule when birthing: One hour to stand, two hours to suckle, and three hours for the mare to pass the placenta. The first rule went well – Zara was standing but had difficulty with the second rule.

“The baby looked fine,” Laura said, “but when she went to nurse she didn’t latch on effectively. She would take a couple of sips and then stop. Usually after the foal ‘gets it,’ they latch on and nurse until they fall asleep.”

Within that second hour, Laura was on the phone with Dr. Cheryl Rusin (UF class of 2002), her primary care veterinarian. Dr. Rusin told Laura she would be over right away and suggested that Laura get her trailer ready for a trip to the UF Large Animal Hospital.

When Dr. Rusin arrived, she examined Zara and drew blood for a complete blood count. Zara’s low white blood cell count, along with clinical signs, which included diarrhea, indicated a possible bacterial infection that needed to be accurately diagnosed and treated immediately. Dr. Rusin called the UF Large Animal Hospital to arrange for the transfer of care to the equine neonatal intensive care unit specialists, gave Zara an antibiotic injection and Laura headed to Gainesville with Bliss and Zara in tow.

Isolated & Specialized Care at UF

The isolation facility at the UF Large Animal Hospital

Laura was greeted by Dr. Rob MacKay, Professor of Large Animal Internal Medicine, and Dr. Martha Mallicote, then- Large Animal Medicine Resident and now- Infection Control Coordinator at the UF Large Animal Hospital, along with staff and fourth-year veterinary students. Because of the clinical signs relayed from Dr. Rusin, Zara and Bliss were immediately taken to a stall in the isolation facility.

“Zara’s diarrhea and low white blood cell count indicated that she may have had an infectious disease and we take these signs very seriously,” Dr. Mallicote said. “The infection control program at UF involves special protocols, like gowning up and the use of our isolation facility, in order to prevent the spread of disease without compromising veterinary care or the well-being of our healthy and sick patients.”

A complete physical examination noted increased heart rate, dehydration, diarrhea and lethargy – all signs indicating sepsis – a bacterial infection of the blood that can be fatal to foals if not treated immediately.

Dr. Mallicote drew blood from Zara for an in-depth analysis of her condition and started her on IV fluids. The blood was submitted for a complete blood count, IgG concentration (to check for antibodies given to the foal via mom’s colostrum), plasma chemistry (to check organ function and electrolytes), blood culture (to detect a blood-borne bacterial infection) and venous blood gas (to evaluate blood pH and electrolytes). A fecal sample was also tested for a panel of infectious diseases.

With the help of the UF Veterinary Diagnostic Laboratories, Zara’s blood work confirmed the low white blood cell count and showed low neutrophil and lymphocyte counts and neutrophil toxicity. Her IgG level was low, indicating that she had not received enough colostrum from her dam, leaving her at increased risk of infection. Fecal diagnostics (cultures, ELISA testing and floats for parasites) all eventually came back negative, though these tests take several days.

Blood was also sent out to test for combined immunodeficiency (CID), a genetic immune system disorder inherited in Arabian foals for which there is no known treatment. CID makes those affected extremely susceptible to infections. Laura also had Zara’s parents tested for CID – all CID tests came back negative.

After the laboratory reports and examination results, Zara was diagnosed with sepsis, which is the presence of bacteria or bacterial toxins in the bloodstream. Sepsis is the most common cause of death in newborn foals and can manifest as pneumonia, diarrhea, meningitis and joint and/or umbilical infections. Unfortunately, neonatal sepsis can occur no matter how careful a horse owner is.

“Foals can be very susceptible to infection because they don’t have the immunity and strength that adult horses have,” Dr. MacKay said. ”There are risk factors for sepsis – placental infections, inadequate colostrum or a difficult birth – but sometimes it occurs even when everything goes exactly right.”

The Road to Recovery at UF

Laura with Zara and Bliss in the isolation stall at UF

Colostrum, a mare’s first milk for her newborn foal, is usually the foal’s initial source of immunity to infections. Unlike human babies, foals do not receive any of this important immunity prior to birth.

“While the IV fluids helped Zara’s dehydration, we also gave her plasma intravenously in order to help her immune system and antibiotics to treat her infection,” Dr. Mallicote said. “We also monitor these foals closely to ensure that they are getting adequate nutrition from their dam. If the foal is unwilling to suckle enough to meet its needs, we can deliver that nutrition via stomach tube or intravenously.  Luckily, Zara did not require that type of support.”

Laura was pleasantly surprised at how quickly Zara became comfortable with being handled and how accepting Bliss was of the veterinarians and staff at the UF Large Animal Hospital. The continuous communication from Dr. Mallicote also helped ease Laura’s fears as well.

“The mare was so well-behaved. It was like she knew they were trying to help,” Laura said. “We came each day and I would suit up so I could pet her and brush the mare and be around them. Even in the serious situation, everybody was so positive and sweet. Dr. Mallicote called every morning when she said she would and report how Zara was doing. It was great.”

Zara got better every day during her stay at the UF Large Animal Hospital. The continuous support from staff and veterinarians, along with the specialized services provided by the large animal medicine service and the veterinary diagnostic laboratories ensured that every diagnosis was made and every treatment option was available. A divided stall (used for neonatal patients) allowed Zara to be treated while still being with her mother, allowing for ease of treatment while keeping the bond between foal and mare.

From Hospital to Home Care

Zara happy at home

After five days, Zara and Bliss were able to go home. Dr. Mallicote called Dr. Rusin with Zara’s treatment instructions to prevent any breaks in care. Sepsis must be treated for several weeks to ensure that the foal does not develop any additional sites of infection and Dr. Mallicote wasn’t willing to take any chances.

“Zara was nursing on her own, the diarrhea had subsided and the IV fluids and plasma had obvious positive effects,” Dr. Mallicote said. “I also instructed that Zara and Bliss be quarantined and for Laura to implement infection control protocols at her farm. Until the bacterial cultures came back, we were unsure if Zara had a type of infection that could be transmitted to another horse so we have to take preventive measures. Laura accommodated to all of the treatment specifications which allowed Zara to be in her familiar home environment which can have a positive impact on the healing process.”

Zara and Bliss at home

At home, Zara became the playful foal that Laura dreamed about. Dr. Rusin provided checkups for Zara to make sure the sepsis was resolving and Laura continued the isolation, antibiotics and continuous support until Zara was healthy.

When asked, Laura said that the two most important things about foal care are constant observation and a good vet.

“You’ve got to keep your eyes on newborn foals,” Laura said. “After they’re born, you can’t go in the house and say, ‘now I can go to sleep because they’re standing.’ You’ve just got to stay alert. The other thing that’s important to me is to have a vet that is going to be there for you when you call, and it’s important that they have an established relationship with the University. When I take an animal to UF, I feel so relieved because I know I’ve done the best I can for them and that they are in good hands.”

Drs. MacKay and Mallicotes’ expertise, the UF Large Animal Hospital isolation facilities and specialists, the compassionate care of students and staff, and the UF Veterinary Diagnostic Laboratories provided the advanced care that Zara needed in order for her to make a complete recovery and for Dr. Rusin to continue providing veterinary care.

Zara is now a healthy two-year-old mare and is a big part of Laura’s farm, Plumwood Arabians, located in Altoona, Fla. Laura’s Arabians specialize in endurance riding and dressage and Zara will soon be a part of that group.

Zara at 2 years old

Dr. Rusin continues to provide care to Laura’s Arabians through her mobile veterinary service, Dragonfly Equine, located in Eustis, Fla. and the UF Large Animal Hospital continues to work closely with referral cases from Dr. Rusin.

“Whenever I see Laura she lets me know how Zara is doing,” Dr. Mallicote said. “It’s wonderful to see the positive results years later from veterinary care that was provided at the UF Large Animal Hospital. Our most challenging cases are often the most rewarding.”

View all UF Large Animal Hospital Success Stories