Farm Tips-Initial First Aid for the Abnormal Foal

Farm tips- Know the initial first aid you can perform on the farm for the abnormal foal immediately post-birth.

In a perfect world, the mare would have a normal parturition, and the foal would be normal after birth and meet the neonatal milestones (1-2-3 rule). Unfortunately, this does not always happen. Foals can be abnormal since birth, especially after dystocia, but also with normal parturition. Clinical signs of an abnormal foal can include but are not limited to apnea or abnormal respiratory pattern, cardiac arrest, weak/lack of suckle reflex, inability to stand or nurse, abnormal behavior, mentation, or seizures, meconium staining, umbilical bleeding, and birth defects.

This blog will discuss what you can do on the farm to provide initial aid/resuscitation for a foal that has been abnormal since birth.

This initial aid will support the foal and buy some time before the veterinarian arrives at the farm, or you can transport the foal to a veterinary hospital.

The initial first aid for the abnormal foal can include but is not limited to:

• Cardiopulmonary Resuscitation (CPR)
• Administer Colostrum
• Madigan Squeeze Technique
• Seizure Response
• Umbilical Care/Hemostasis
• Enemas
• Temperature control/Nursing care

Immediately post-foaling, a foal’s normal respiration rate is 60-80 breaths/min. If the foal is not breathing, assess the patency of the airway first and then stimulate or establish breathing.

Assess the patency of the airway- Horses are obligate nasal breathers; therefore, evaluate if the nostrils are occluded and prevent the foal from breathing. Nostril occlusion can result in asphyxiation.

-Remove any amnion from the nose, face, and neck if present.

-Remove any mucus or excessive fluid from the nostrils if present.

-If the airway is patent, but the foal is not breathing, stimulate or establish breathing.

Stimulate or establish breathing- Stimulate the foal to breathe. Rub with a clean towel, stick a piece of straw in the nostrils, or your fingers in the ears.

Ventilation- If the foal is still not breathing, one can attempt to manually ventilate the foal with an E-Z Breather Foal Resuscitator (click to be redirected to the animal reproduction systems, ink. website for purchase) or Ambu bag with a mask. If you do not have that equipment, mouth-to-nose resuscitation can be performed.

E-Z Breath Foal Resuscitator or Ambu bag with mask– Place the foal on its side and ensure no fluid or mucus in the nostrils. Place the plastic cone or mask over the foal’s nose. Compress the bag with your hand to deliver a breath; deliver 10-20 breaths a minute. You should visibly see the chest expand with each breath.

Air can go into the esophagus when manually ventilating. Apply gentle pressure on the esophagus (left side of the neck) to prevent air from entering the gastrointestinal tract. Reassess 30 seconds later to check if the foal is breathing. If the foal is breathing, place it in sternal recumbency. If the foal is not breathing, continue breathing for the foal.

Mouth-to-nose resuscitation- Place the foal on its side, make sure there is no fluid or mucus in the nostrils, extend the foal’s neck, hold off the down nostril, and breathe into the up nostril. Deliver 10-20 breaths a minute.

Immediately post-foaling, a normal heart rate is 60-130 beats/min. Place your hand over the foal’s chest behind the triceps muscle and feel the heartbeat. You can also feel for a peripheral pulse.

Perform chest compressions if there is no heartbeat or if the heart rate is less than 50 beats/min and the foal is weak, lacks sternal reflex, or is non-responsive. The compression rate should be around 100 beats/min.

-Place the foal on a hard surface and be in a kneeling position at the side of the foal’s back (spine).

-Place your hands on top of one another, lock your elbows, and position your hands caudal to the foal’s triceps at the highest point of the thorax. Your shoulders should be directly above your hands, allowing the help of your body weight to compress the thorax.

-Perform compressions for 2 minutes, then assess for a pulse. Repeat the cycle if there is no pulse or heartbeat.

–Respiratory arrest is more likely to occur than a primary cardiac arrest; therefore, establish ventilation as soon as possible.

1-2-3 rule: A foal should stand within 1 hour and nurse within 2 hours of birth. The mare should pass her placenta by 3 hours. If a foal is weak, has an abnormal suckle, or has not nursed by 3 hours, it is at risk of failure of passive transfer and hypoglycemia. Put your finger in the foal’s mouth to assess the foal’s suckle reflex. Ensure your hand is clean or you are wearing an exam glove.

Give the foal the mare’s colostrum. Gently wash the mare’s udder, milk the mare, and strain the colostrum into a clean container.

Nasogastric foal feeding tube: A weak foal or one with a poor suckle is at risk of aspiration if fed through a bottle. It is best to have a veterinarian or trained attendant pass a nasogastric feeding tube and administer the milk that way.

Here are some examples of tubes that can be used to administer colostrum: Initially feed approximately 100-150ml (4.5 oz) for a 50kg foal.

If it will be several hours before a veterinarian can see the foal and there is no trained person to pass a tube, then colostrum can be administered with a syringe or bottle.

When feeding milk to a foal with a syringe or bottle, always have the foal in a sternal upright or standing position. Never feed milk through a syringe or bottle if the foal cannot swallow or is lying on its side because of the high risk of aspiration pneumonia.

Syringe small volumes at a time and use a nipple that has a small hole. Foals with a good suckle and swallowing ability are at less risk of aspiration. Initially feed approximately 100-150ml (4.5 oz) per hour for a 50kg foal.

Perform the Madigan Squeeze on a Maladjusted foal that is systemically healthy but shows abnormal signs such as delayed nursing, abnormal nursing behavior, abnormal suckle, and lack of affinity to the dam. There are many more clinical signs that are suggestive of maladjustment syndrome.

The Madigan Squeeze mimics the birthing process when the foal is being squeezed through the mare’s birth canal. The squeeze is to help reduce higher levels of neurosteroids in maladjusted foals. Neurosteroids keep the foal in a somnolent state while in utero, but levels rapidly reduce post-birth to transition the foal to extra-uterine life.

Duration of squeeze procedure: A foal is squeezed for 20 minutes.

The Madigan Squeeze can also be used as foal restraint in foals <3 days of age.

Palpate the foal’s ribs very carefully, and if there are broken ribs or the foal is in respiratory distress, do not perform this procedure.

Go to this website, www.equineneonatalmanual.com/foalsqueezing, to watch videos on how to perform the Madigan Squeeze and read more scientific articles on Neonatal Maladjustment Syndrome.

If a foal has an abnormal mentation or seizures, have the foal evaluated by a veterinarian immediately.

During transport to the hospital, keep the foal protected to prevent harm. Sit with the foal in the trailer or put the foal in the vehicle with you.

If there are concerns for seizures due to hypoglycemia, rub some Karo syrup on the gums.

If the attendant can perform intravenous injections, then administer midazolam (0.1-0.2mg/kg, IV) (start with 5mg per 50kg foal). Or use diazepam (0.1-0.2mg/kg, IV) (5-20mg/ 50kg foal).

Umbilical care is very important. The umbilical stump is a route of entry for bacteria. Hence, if the umbilicus is not cared for properly or monitored, it can lead to infection, in layman’s terms, naval illness.

If the foal is born with the umbilical cord still attached and the mare and foal are lying quiet, then allow the cord to break on its own.

If there is a need to break the umbilical cord- Break it with your hands at the natural spot it wants to break (approximately 2 inches from the foal’s body wall). Never pull the cord where it puts pressure on the foal’s body wall.

Breaking the cord with your hands, thus creating a tearing action, will help the umbilical vein and arteries contract, causing less bleeding, rather than a blunt cut with a sharp object (e.g., scissors).

Always check the cord after the foal is born for bleeding.

If there is bleeding, then tie off the umbilical stump with umbilical tape about 1-2 inches from the foal’s body wall. You can also use umbilical clamps, But these are harder to remove.

Foals can have a significant amount of blood loss from umbilical bleeding.

Disinfect the umbilicus immediately after birth with 2% chlorhexidine diluted to make a 0.5% solution (1 part chlorhexidine with 3 parts sterile water). Disinfect 4 times for the first 24 hours and monitor for heat or swelling. The umbilicus should become dry and contracted. There should be no heat, swelling, pain, external fluid, or moisture from the umbilicus.

If a foal is straining to defecate, enemas are commonly performed to help the foal pass meconium. Enemas can help prevent meconium impaction. Foals usually pass meconium within the first 1-4 hours after birth.

To perform an enema- Use a fleet enema (prepackaged bottle) or a warm soapy water enema.

Purchase fleet enemas at a local drug store or online. Fleet enemas contain phosphorus, which can result in excessive phosphorus levels if given too frequently. Limit fleet enemas to 1 or 2 within 24 hours.

To perform a soapy warm water enema, mix a small amount of ivory soap with warm water (approximately 120-250ml), place lubrication onto a soft, narrow rubber tube (pictured above is one type of tube), and insert gently into the foal’s rectum. Be careful not to cause injury to the rectal mucosa. Connect a funnel or syringe with the plunger removed to the other end of the tube and pour the water in by gravity.  

A normal temperature for a foal is 99.0-101.5F (37.2-38.6C).

Foals have a higher metabolic rate and higher surface area to body weight ratio and can lose heat quickly.

In the colder months, keep the foal dry and warm. If the foal is sick and declining, monitor its temperature, and if the foal is below 99.0F, use blankets and warming devices to prevent hypothermia. The opposite is true in the warmer months and in hotter regions. Monitor temperature and make sure the foal does not overheat.

• Normal respiration rate is 60-80 breaths/min (first 30 minutes). By 1-12 hours, the respiratory rate is 30-40 breaths/min.
• Normal heart rate is 60-130 beats/min (for the first hour). By 24 hours, the heart rate is 80-120 beats/min.
• Normal temperature is 99.0-101.5*F.
• Normal time to pass meconium is within 1-12 hours post-birth. Most foals pass meconium within the first 1-4 hours.
• Normal time to pass urine is usually within 6-10 hours post-birth.
• Time to stand within 1 hour. Longer than 2 hours is considered abnormal.
• Time to nurse within 2 hours. Longer than 3 hours is considered abnormal.
• Sternal recumbency occurs 1-2 minutes post-birth.
• Suckle reflex is present by 2-20 minutes post-birth.

If there are no problems with the birth and the foal is sternal, breathing normal, has good muscle tone, and is not bleeding excessively from the umbilicus, allow the mare and foal 20-30 minutes by themselves while you observe from a distance. Afterward, disinfect the foal’s umbilicus, remove any bloody straw, and replace it with clean straw or bedding. Ensure the foal stands and nurses within 2-3 hours to receive colostrum as soon as possible. Monitor that the foal passes meconium; if the foal is straining, perform an enema. Have your veterinarian perform an IgG check and a new foal exam when the foal is 12 hours of age.

Know the vaccination status of the mare. Talk with your veterinarian about vaccination guidelines and time frames for foals born to vaccinated mares vs unvaccinated mares.

If the foal is born to an unvaccinated mare against tetanus, your veterinarian will likely give the foal a tetanus toxoid vaccine at the appropriate time (usually within the first 1-4 months of age). It might not be as common practice to administer tetanus anti-toxin to a newborn foal born to an unvaccinated mare as it once was because of the risk of serum-associated hepatitis (aka Theiler’s disease).

Once stage 2 labor occurs (rupture of chorioallantoic membranes aka water breaking), the foal should be born within 20 minutes. You should see the progression of the foal’s two front feet and the foal’s muzzle. If 10 minutes of stage 2 labor produces no signs of forelimbs or head at the vulva, examine the mare in a clean fashion for the fetal position. Call your veterinarian and have an assistant help you.

Newborn Foal Exam

Neonatal Foal Behavior- What’s normal

Signs of Foaling