Saving the vulnerable the Waikato Equine Intensive Care Unit is a godsend for critically-ill foals, as Angela Hawker BVSc(dist) MACVSc reports

Foaling season is here again, and with it come high hopes for the results of last year’s careful planning. Time, money and emotions have been invested to deliver strong, healthy foals. So what happens when things don’t go according to plan? Mare illness, difficult foalings, and a range of conditions in newborn foals can threaten a happy outcome.
The Waikato and surrounding areas are very fortunate to have help on hand at the Waikato Equine Intensive Care Unit (WEICU). This facility was set up to provide experienced nursing care 24 hours a day for critically ill foals (or mares if needed), as well as other services such as fostering foals.
Set up by equine veterinary nurse Anne Benjamin eight years ago, the unit is now run by a trust comprising local veterinarians and breeders, with support from sponsors, and is located in Cambridge.
Nurses who have international experience in caring for foals provide nursing care around the clock. Head nurse Rebecca Johnston had considerable experience in the intensive care unit in Geulph, Ontario and has returned to Cambridge after spending the Northern Hemisphere breeding season at the highly-regarded Rossdale Equine Hospital in Newmarket, England.
Extensive veterinary supervision is necessary for managing sick foals, and the client’s own vet may oversee the case, or the little patients can be referred to one of the local equine practices. There are three vets from different equine practices who manage the majority of ICU cases. All have spent time in major equine hospitals with a high foal caseload overseas, and have a special interest in neonatology (medicine of newborns).
So, what sort of things can go wrong with newborn foals that the unit can help with?
Orphans
Losing a mare is traumatic enough without the exhausting task of raising an orphan foal. Raising a very young foal without a mare can also be detrimental in terms of ending up with inappropriate socialisation of the foal. It is much better if the foal can be fostered to another mare – generally one who has lost her own foal.
The Cambridge unit has a database that attempts to match foals to mares, by way of a telephone network that people can phone if they have a mare or a foal in need. Once a match is found, they can be paired up at the unit. The fostering service is highly successful and can be arranged directly through the unit without the need for referral from a vet, although any health concerns with mare or foal can be directed to a vet promptly.
‘Dummy’ foals
This syndrome has many different names. The veterinary term for the condition is hypoxic ischaemic syndrome, or neonatal maladjustment syndrome. This refers to the currently accepted cause of the problem, which is a period of oxygen deprivation either during late gestation (through placental insufficiency or maternal illness) or during the foaling process. Many of the foal’s body systems can be affected, either singly or more than one at a time, including the brain, gastrointestinal tract and kidneys most commonly, since these require a lot of oxygen.
The signs can vary widely, and can often be seen 24 to 48 hours after the foal has been apparently normal. Some symptoms are as mild as a ‘normal’ foal who can’t find the teat or has no idea what to do when he gets there, or can be severe enough to result in a ‘down’ foal with seizures. 
The mild cases may not require intensive care, but still need feeding two-hourly, often with the help of a stomach tube if there is no suckle reflex. Many horse owners aren’t able to keep up with the demanding hours, and also may not be comfortable feeding a foal through a tube.
The severe cases need to be managed on a bed to avoid pressure sores from being prone, and may need high-level care including seizure medication.
The good news is that the vast majority of these foals, even those that suffer seizures, recover fully with no long-term complications, as long as they are managed appropriately and do not develop secondary complications.
Septicaemia
The consequences of a bacterial infection in a newborn foal can be severe and life-threatening. Foals can be born septicaemic if there has been infection of the placenta or severe infection in the mare, or they can acquire an infection before they have been able to ingest sufficient colostrum.
It is now thought that the majority of infections are acquired through ingestion of bacteria from the environment rather than through the navel, as was once thought (although disinfection of the navel at birth is still recommended).  
The newborn’s gut is highly absorptive because of the need to absorb protective colostrum, and also absorbs bacteria, which then get into the blood. From here, the infection can spread and localise in areas such as joints, lungs or other organs.  Colostrum intake is important to provide immunity against invading pathogens. Ensuring the mare foals in a clean paddock or stall, and has clean legs and a clean udder, will decrease the bacterial load the foal is exposed to.
For this reason, it is not recommended that probiotic pastes are given to newborn foals, as these contain billions of bacteria, which may be beneficial in a mature gut but quite harmful in the bloodstream of a newborn.
Signs that a foal is ‘septic’ can be similar to those shown by a dummy foal (for example, weakness and loss of the suckle reflex) or can be quite localised, such as a lameness from an infected joint.
Very sick foals are in septic shock, and need intravenous fluids, antibiotics, oxygen and support of blood pressure.
Premature and Caesarean-section foals
These often come with multiple problems and frequently need specialised care. The chances of survival increase the nearer the foal is to full gestation. Mares tend to be reasonably consistent in their own pregnancy lengths, so knowing how long is normal for your mare is very useful.

Contracted tendons
Some foals are unable to stand without knuckling over, but with regular assistance with feeding, supportive care and aggressive treatment, many can make full recoveries.
Neonatal isoerythrolysis (jaundice)
This occurs when mares with a different blood type to their foal become exposed to these foreign proteins during pregnancy or following a previous pregnancy. They then produce antibodies against the foal’s red blood cells. When the foal is born and suckles, these antibodies are absorbed, attacking and destroying the foal’s red blood cells. The foal may need a blood transfusion to survive. The condition can be prevented by feeding alternate colostrum until the gut has ‘closed’.
Diarrhoea
Severe cases of scours can mean a foal cannot keep up with fluid losses and has to be maintained on a drip. The unit has a separate isolation unit where these foals can be managed away from other foals to avoid the spread of disease. Electrolyte losses can also be measured and replaced as needed.
Facilities and services
WEICU is well equipped to provide care at all levels, from fostering to managing critically ill ‘bed babies’. Because there are experienced staff present at all times, foals that are unable to stand can be turned or stood regularly (to avoid lung congestion or bed sores), receive oxygen and fluid therapy, and have all vital signs including blood pressure and oxygenation monitored and treated as needed.
The veterinarian in charge of the case can be called as needed at any time and all cases are examined as many times a day as necessary. Antibody levels are checked and a plasma transfusion can be given if inadequate colostral transfer has occurred. 
Feeding tubes are placed for foals without a suckle reflex to be fed, and if the gut is unable to process milk, as can happen in very ill new-borns, nutritional needs can be supplied intravenously until milk is tolerated. Many of these foals, who would almost certainly have died in the past, are able to make full recoveries.
Contrary to popular belief, many foals that start life in this way go on to become completely normal adults, and do not show signs of lasting impairment.
WEICU has a success rate of approximately 75%, comparable to that achieved by similar facilities overseas.
One of the unit’s recent success stories is a septic, three-weeks premature thoroughbred colt who was unable even to lift his own head. He was maintained on intravenous nutrition for over a week, and went on to sell for more than $300,000 at the Karaka sales. Without doubt, providing such a service doesn’t come cheaply to the owner. The lower case-load in New Zealand compared with overseas means that each year it is a struggle for the unit to even cover its overhead costs.
The first day of treatment for a very intensive case usually costs around $1000. This covers all initial stall set-up costs. Each subsequent day depends on what level of care is required. If the foal is able to get up and move around the box, the cost is much less than a foal who is on a bed and has to be lifted and turned every one to two hours.
The unit tries to keep foals in for as short a time as possible, although discharge time will vary depending on the experience and facilities of the owner.
An important factor in improving the prognosis and keeping a hospital stay to a minimum is early intervention. In newborn foals, the situation can change rapidly and often prompt referral to experienced intensive care means ‘turn-around’ time is kept to a minimum.
Sometimes 24 to 48 hours is all that is needed for a foal born weak, or with a high likelihood of being at risk, to break the cycle of weakness and overwhelming infection.
Many of the Waikato studs send foals in immediately after birth if there is a high likelihood of compromise, such as meconium staining or a ‘red bag’ delivery.
For busy studs or owners without staff or facilities to spare for the time-consuming task of nursing sick foals, WEICU can be an important resource.
Without this facility, a number of valuable foals would be lost, as well as a year’s breeding for the mare.
While the current clients are predominantly from the thoroughbred industry, with the number of valuable embryo transfer and frozen semen-bred sporthorses on the increase, the unit will become increasingly valuable to the sporthorse industry. 
Because WEICU is run by a trust, which works to maintain this valuable service to the equine industry, it is particularly grateful for donations from sponsors. Without their support and support from the equine industry, 24-hour experienced nursing care and facilities of this standard would be extremely difficult if not impossible to provide. A list of sponsors can be found on the website; www.weicu.zoomshare.com. If you wish to contact the unit, the mobile telephone number is 021 493428.