PHYSICAL EXAM OF THE EQUINE NEONATE
A. Mare current and past pregnancy complications.
B. Parturition – duration – complications.
C. Post foaling times for standing, nursing, etc.
1. Medication or procedures performed post-birth.
2. Umbilical care.
3. Meconium passage.
4. Urination observed.
D. Environmental factors – infectious disease present, previous farm problems.E. Short form for neonatal post birth evaluation (example p. 46).
II. EXAMINATION OF FOAL – RECORD ALL FINDINGS
A. Observe from a distance initially.
1. Note degree of alertness and maternal interaction.
2. Assess general conformation.a. Watch movement and gait and look for evidence of pain or lameness.
3. Observe respiratory rate and character.
a. Normal is 30-40 breaths/min if environmental temperatures are moderate.
b. May be 60-80 with high environmental temperature.
c. Small abdominal component of breathing cycle at end expiration is normal.
d. Marked abdominal component with flared nostrils and exaggerated rib retractions or grunting is abnormal.
e. Premature foals can exhibit abnormal paradoxical breathing pattern consisting of inward motion of the rib cage during inspiration out of phase with outward motion of abdomen.
f. Recall metabolic acidosis and response to pain causes increased respiratory rate.
B. Evaluate size and maturity with regard to stated gestational age.
C. Observe for “milk face”1. Milk from full, non-nursed upon mammary gland may run onto foal’s forehead.
D. Obtain temperature, pulse and respiration of the restrained foal.
1. Pulse normal 80-120 beats/min.
2. Temperature 99-101.8˚F (37.2-38.8˚C).a. High environmental temperatures can alter the foal’s afternoon temperature.b. A.M. temperatures are best used for daily comparisons using a temperature chart.
3. Immediate post birth rectal temperature can fall to 98.6˚F.a. Shivering in cold environments is normal for 3-4 hours to generate heat.
E. Systems exam: Start at the head.F. Cardiovascular
1. Mucous membranes – normally pink and moist.
a. Not a good indication of degree of oxygenation of blood.
b. Scleral injection seen with toxemia or conjunctivitis.
c. Petechial hemorrhage – normal to have episcleral hemorrhages from pressure of birth canal. Abnormal on gums, tongue, palate, vulva or pinnae of the ears.
d. Icterus, if severe suspect neonatal isoerythrolysis or liver problem.
2. Capillary refill time 1-2 seconds.
3. Arterial pulse quality.a. Normal is just detectable – use fingertips, check at facial, brachial and great metatarsal.
4. Jugular pulses are abnormal.a. Assess jugular distensibility, should fill up briskly if not hypovolemic.
a. Common to hear a holosytolic grade I-IV murmur at left heart base over third intercostal space for up to one week, believed associated with ductus arteriosus.
b. Louder murmurs with palpable thrills associated with congenital defects. See Chapter 41.
6. Blood pressure.
1a. Doppler tail method in lateral recumbency day 1 systolic 81 ± 10 mmHg, diastolic 35 ± 7 mmHg, day 7 systolic 104 ± 21 mmHg, diastolic 40 ± 14 mmHg.
7. Distal extremities and ears should be warm with adequate circulation in a neutral thermal environment.
G. Respiratory system
1. Ausculted sounds are louder than in adult.
a. Increased rates may produce abnormally loud and harsh sounds.
b. Inspiratory sounds louder than expiratory normally.
c. May hear air moving over entire lung field with no wheezes or dullness and find significant abnormalities in a thoracic radiograph from interstitial disease or edema.
2. Down lung in premature foals can become quieter and congested just from body position.
3. Changes in respiratory rate over time may indicate increased compromise of respiratory function as well as pain, environmental temperature response, metabolic responses or transient tachypnea syndrome.
4. Best pulmonary function test in veterinary medicine is an arterial blood gas.a. Oxygen levels reflect respiratory component.b. CO2 levels reflect ventilation component
5. Coughing as a symptom is not a common component of severe pulmonary problems in neonatal foals.
6. Always evaluate patency of airway in a respiratory distress situation.
H. Gastrointestinal System
1. Examine oral cavity for bite, cleft palate, and pharyngeal paralysis.
2. Observe nursing behavior and swallowing.
3. Check medial canthus of eye and skin for meconium staining which may indicate in utero stress.
4. Gut sounds – normal to hear gurgling in four quadrants.
a. Right and left ventral and right and left dorsal abdominal areas.
5. Observe any abdominal distension – can be associated with:
a. Impending enteritis or ileus.
b. Colonic torsion or volvulus if painful.
c. Gastric distension associated with over feeding in premature foals.
d. Obstruction from high meconium impaction or GI congenital defect.
e. Uroperitoneum associated with ruptured bladder or urachus.
f. Fulminating peritonitis.
6. Check for passage of meconium (dark brown to black) and patency of GI tract.
a. Ileocolic aganglionosis, overo-overo breeding (white foals).
b. Atresia ani or coli in any breed.
I. Genitourinary System
1. Urination usually occurs by 8.5 hours.
a. Specific gravity low 1.001-1.015.
b. Urethral mucous plug in some males.i. Attempt to urinate – improves following catheterization
c. Persistent preputial ring in males.
i. Inability to extend penis.
d. Vulva and clitoris, abnormalities are enlargements possibly reflecting chromosomal problems.
e. Check scrotum for both testicles and for scrotal hernia.
J. Umbilical region
1. Size, heat, tenderness, moisture, edema.
a. Should learn normal appearance for age.
b. Consider ultrasound (See Chapter 52).
2. Patent urachus.
a. Moist hairs around navel or urine scald on inside of legs.
3. Palpate for hernia.
K. Eye – use penlight and ophthalmoscope
1. Check for ulcers or uveitis.
2. Congenital lesions – cataracts, etc. Chapter 42.
3. Pupils should be equal, large and circular in one day old foal and become small and more oval by one week of age.
4. Pupillary light response can be sluggish if foal is excited and has sympathetic override.
5. Menace response is lacking in normal foals until two weeks of age.
6. Entropion is common in ill and premature foals.
L. Musculoskeletal System
1. Conformation – avoid being over critical in first 12 hours of life.
2. Observe motion and gait.
3. Contracted tendons and weak flexor tendons often improve within a few days.
4. Angular limb deformities if not severe are best re-evaluated in a few days.
5. Check joints and physes for heat, swelling or pain.
6. Fractured ribs at birth – check closely.
7. Passive range of motion is increased along with greater fetlock drop in premature foals.
a. May correct remarkably well if left alone and foal can nurse.
8. Wry neck and face.
a. May correct somewhat if left alone and foal can nurse.
9. Scoliosis and kyphosis often associated with contracted limbs.
M. Neurologic System
1. General attitude and behavior – foals are normally “hyper”, swift and “jumpy”.
a. Stands within 2 hours.
b. Recognizes mother and mammary glands.
c. Usually easily aroused by individuals; however, can deeply sleep and require stimulation to rise, especially after 2 weeks of age.
2. Cranial nerves.
a. Optic nerve II.
b. Pupils – normal unless excited.
3. Trigeminal nerve (V) foals are hypersensitive and overreact compared to adult to tactile stimuli.
a. Palpate temporal, masseter and digastricus for symmetry.
4. Facial nerve (VII).
a. The ear, eyelid, lip and nostril reflexes (V sensory – VII motor).
b. Same as adult but jerky.
5. Vestibulococlear (VIII)
a. Can hear at birth but exaggerated jerky response.
b. Vestibular nystagmus (normal) with head movement seen at birth.
6. Glossopharyngeal (IX), vagus (X), spinal accessory (XI).
a. Ability to swallow – check with tube.
7. Milk in nostrils may be weakness, cleft palate or temporary pharyngeal paralysis syndrome.
8. Feeding requires:2 swallow (IX, X, XI), reflex lip movement (VII), jaw (V), and tongue (XII), and recognition – sight (II), and awareness of dam (cerebrum).
9. Hypoglossal nerve (XII)
a. Many foals hang tongue out of mouth, normal (behavioral) if the tongue is retracted when stimulated by touch.
10. Unique reflexes of the neonatal foal.
a. Flexor or withdrawal reflex causes crossed extension of the contra lateral limb up to 3 weeks of age.
b. Patellar reflex is brisker and more exaggerated and can be followed by clonus in neonatal foals.
References:1. Lombard C.W., Evans M., Martin L., Tehrani J.: Blood pressure, electrocardiogram and echocardiogram measurements in the growing pony foal. Equine Vet J 16:342-346, 1984.2. Adams R., Mayhew I.B.: Neurologic examination of newborn foals. Equine Vet J 16:306-313, 1984.3. MacKay RJ Neurologic disorders of neonatal foals. Vet Clin North Am Equine Pract. 2005 Aug;21(2):387-406.
Neonatal Post Birth Evaluation Form Mare: _______________ Date Last Bred: ____________________Sire: _______________Expected Foaling Date: _______________Date Foaled:_____ Time Foaled:______ Sex:____Color:_________ MARE:History of Previous Foal Problems: ______________________ ________________________________________________ History of Problems During Pregnancy: ___________________ ________________________________________________ Assistance Required: ________________________________ ________________________________________________ FOAL:Time to Stand: ______________________ Chlorhexidine: ___ Time to Nurse: ______________________ Enema: _________ Meconium Passage: _________________________________ Colostrum Absorption ________________________________ Urination Normal: _______________________PCV:________ Colostrum Harvested: ____________________CSG:________ MARE:Placenta Passed: ________Temporary Vulvar Closure:__________Placenta Condition: _________ Milk Let Down: ________________Premature Separation?: ___________________________________ FOAL EXAMINATION CONCERNS:Laboratory Data Requested: ______________________________________________________Level of Observation Requested: _______________________ Recheck In: _________DATE_________________ TIME_______________________ COMMENTS __________________________________________
CAPITULO 11 DO LIVRO EQUINE NEONATAL MEDICINE