Late one evening a Thoroughbred mare in late pregnancy at 312 days (normal gestation in horses is 340 days) was presented to the hospital with signs of severe colic. The mare was immediately rushed into surgery; exploration of the abdomen revealed a ruptured stomach which carries a grave prognosis. The decision was made to deliver the foal via cesarean section before the mare was euthanized.

A foal that is born before 320 days gestation is considered to be premature. The survival rate for premature foals is about 50% after natural birth and only about 20% to 25% for foals that result from early cesarean section. The final maturation of several organ systems, especially the respiratory tract occurs during the last days of gestation after an increase in the foal’s cortisol level. At the same time the hematopoetic (blood cell) system produces the white blood cells necessary for fighting infections after the foal is born. The increased cortisol level leads to an increased excretion of thyroid hormones, which regulate a number of important physiologic functions including bone development. A small body size, short and silky hair coat, increased range of motion of joints, and immature skeleton ossification are commonly seen in most foals born before 320 days.

The delivered foal was a bay colt and because he was under the effect of his dam’s anesthesia, he had to be resuscitated. His heart was beating at a regular rhythm but the respiration was nearly completely suppressed by the anesthetic drugs. After clearing his airway from fluid an endotracheal tube was passed in order to provide oxygen. He was then treated with Doxapram (a respiratory stimulant) and he began breathing. The foal was transferred to a warm intensive care stall where he was placed on intranasal oxygen therapy, intravenous fluids, anitbiotics, and antiulcer medication. All foals are born without sufficient antibodies and therefore have to receive colostrum, the first milk the mare produces. Colostrum is rich in antibodies and the healthy foal’s gastrointestinal tract absorbs these antibodies within the first 6-8 hours after birth. A healthy foal has to consume approximately 1-2 pints of colostrum in order to be protected from infections. Inadequate colostral antibody transfer, otherwise known as failure of passive transfer (FPT) may be caused by the mare not producing a good quality colostrum, or leakage of lactation prior to labor, or from the foal not nursing a sufficient amount of colostrum, or failure of the foal’s GI tract to absorb antibodies. If FPT is diagnosed during a newborn foal examination a plasma transfusion may be necessary to ensure a sufficient level of antibodies. The foal from the cesarean section had no colostrum available and received several liters of plasma through an intravenous catheter. The colt could not stand, nurse, or even hold his head up and was placed in a specially made bed to prevent decubital ulcers (bed sores). He had to be maintained in sternal recumbancy (lying upright) and was frequently turned from side to side to ensure adequate ventilation of all lung fields.

For almost a week, all day and night, a veterinarian and hospital technician remained by his side. A nasogastric tube was placed so milk replacer could be fed to him every hour. Continuous intravenous fluids with electrolytes were given for proper hydration and the oxygen therapy continued. Antibiotics were given to prevent systemic (blood) infection. Radiographs were needed for signs of lung collapse or pneumonia and for bony development. Four days after his birth, he started to become alert and raise his head to look around. The nasogastric tube was removed and he was able to drink the milk replacer from a small pail. Standing with assistance for very brief intervals came next.

After a week, the colt was able to be removed from his foal bed and could be unattended for short periods. He was able to stand and lay down on his own with assistance. Slowly the antibiotics and intravenous fluids were discontinued. As it happens, another newly born colt who had also lost his dam to colic was admitted to the hospital and the two orphans were placed together for companionship. Now this colt is almost a yearling and continues to thrive and shows no evidence of his rough start at life.