1 / 25

NEONATOLOGY

NEONATOLOGY. Prepartum evaluation. Evaluation should include assessment of the placenta, repro system and fetal fluids Transrectal palpation Transrectal and transabdominal ultrasound After 6 months of gestation use both types of ultrasound

dillon
Download Presentation

NEONATOLOGY

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. NEONATOLOGY

  2. Prepartum evaluation • Evaluation should include assessment of the placenta, repro system and fetal fluids • Transrectal palpation • Transrectal and transabdominal ultrasound • After 6 months of gestation use both types of ultrasound • Do not do vaginal or speculum exam (increased risk of infection)

  3. Readiness for birth • Hard to determine therefore induction is not recommended • Udder development • W/in last months of gestation • Secretion thin watery and clear then start to increase in opacity d/t increasing calcium levels • Pulmonary maturity • Amniotic fluid lecithin/sphyngomyelin rations are not predictive in the foal • Abdominocentesis has a high risk of abortion • Interfere if there is persistent fetal tachycardia

  4. Specific fetal evaluation • Fetal HR from 65-115 bpm (episodic bradycardia/tachycardia occurs) • Persistent tachycardia is a sign of fetal distress

  5. Postpartum evaluation • Should be standing by 2 hours • Should start nursing no later than the first 3 hours • All of the meconium should be passed by 36-48 hours • First urination at 8.5 hours (longer for fillies) • Temp: 99-102 F • Resp: 60-80 breaths/min decreases to 30 breaths/min w/in first hour

  6. Postpartum evaluation • CV system • 40-80 beats/ min immediately after birth • Increases to 120-150 beats/ min for several hours • Stabilizes to 80-100 beats/ min w/in first week • L to R PDA may be normal in the first 24-48 hours; the foal may then close the PDA (if it reopens the foal may have oxygen tension problems) • Nervous system • Immature cerebellum when born • May note excessive jerky movements • Usually goes away within the first few months

  7. Meconium Impaction • MOST FREQUENT CAUSE OF COLIC IN THE NEONATAL FOAL • Time period: usually within first 24 hours (can be a couple days later if it’s a high impaction) • Etiology: high (large colon) or low (small colon) • CS: similar to adult colic • Tx • Enema’s: mild soapy solution or acetylcystein diluted in water with bicarb • Mineral oil by NG tube • IV fluids

  8. Ruptured Bladder • Colic starts 24-72 hours after birth • Signalment: male foals more commonly • Risk factors • Difficult births • Umbilical/urachal infections • CS • Similar to meconium impaction • Straining posturing to urinate • Pathophysiology • Rupture due to excessive pressure on a full bladder (during travel through the pelvic canal)

  9. Ruptured Bladder • Dx • Serum chemistries: hyponatremia/chloremia, hyperkalemia; BUN and Cr elevated • Abdominal ultrasound: peritoneal effusion • Contrast cystogram of the bladder (see the hole) • Abdominocentesis: elevated Cr, infuse bladder with methylene blue and check color of fluid via abdominocentesis

  10. Ruptured Bladder • Tx • Medical emergency (not a surgical emergency) • Stabilize patient prior to sx • Drain abdomen to remove K • Fluids (avoid K containing fluids) • Sx repair of the bladder

  11. Uroabdomen • Indistinguishable from ruptured bladder • D/t leakage from the urachus near or at the attachment to the bladder • Develops in foals with sepsis and urachal infections

  12. GI Ulceration • Occurs due to stress or NSAID toxicity • Up to 50% of foals develop GIT ulcers within the first 3-4 months • Lesions in the squamous mucosa are due to gastric acidity issues • Lesions in the glandular mucosa is due to mucosal protection issues • CS: similar to meconium impaction • Typically CS at 24-72 hours of age • Colic- dorsal recumbency • Ptyalism • Most have lesions in the non glandular portion but <5% show CS

  13. GI Ulceration • Dx • CS • Endoscopy • Fecal occult blood, gastric content blood • Tx • H2 blockers: cimetidine, ranitidine, famotidine • Omeprazole: complete blockage of acid secretion but not yet approved for foals < 30 days old

  14. UlcersAdults vs foals

  15. The Sick Foal • Premature: foal of gestational age less than 320 days • Dysmature: foal born at >325 days but displaying characteristics of immaturity or being undersized • Small for gestational age • Intrauterine growth retardation: neonate having suffered arrested, altered or slowed development due to some derangement in intrauterine environment

  16. Prematurity • Physical characteristics • Decreased suckle reflex • Short, silky coat • Hyperextension of the fetlocks • Floppy ears • Labored respirations (atypical) • Metabolic and lab characteristics • Temp fluctuations • Leukopenia w Neut:Lympho ratio close to 1 • Low resting cortisol • Abnormal cortisol stimulation: poor response to ACTH

  17. Prematurity • Dx • Hx, PE, complete lab evaluation • Neuro evaluation: weak and quiet, sleep more • Cuboidal bone ossification index • 1- some cuboidal bones show no evidence of ossification • 2- all cuboidal bones show some ossification • 3- cuboidal bones small and rounded- larger joint spaces • 4- normal ossification • Therapy: • Nursing care • Immunologic support: colostrum, Ig administration

  18. Failure of Passive Transfer • PFPT = Serum IgG<800 • Total FPT = Serum IgG<200 • Predisposing factors • PREMATURITY is the #1 risk factor • Mare factors: poor quality (primiparous), loss prior to birth • Foal factors: poor ingestion, GIT absorption problems

  19. Colostrum • Epitheliochorial placentation in the horse allows for no transfer of Ig’s in utero • Colostrum provides • Ig’s, energy requirements, growth factors, leukocytes, laxatives, various factors which enhance the intestinal absorption of the colostrum • How is it produced • Serum Ig’s get extracted and concentrated in the mammary gland. • Usually in last month of gestation the mare is vaccinated to increase levels of Ig’s in colostrum • Good quality IgG content >3000 mg/dl (SG > 1.060)

  20. Immunological Asssessment of the foal • Test the foal no later than 12 hours post birth • Should have at least 800 mg/dl • Single radial immunodiffusion “gold standard” • Expensive, results take 24 houss • ELISA (CITE test) • Rapid, easily acts as its own control • Snap test available

  21. Treatment of FPT • If <12 hours: administer colostrum • If between 12-24 hours • <400: good colostrum or plasma transfusion • >400: good colostrum • If greater than 24 hours: plasma transfusion, use commercially available frozen plasma

  22. Neonatal Septicemia • FPT IS THE MAJOR PREDISPOSING FACTOR • Etiology: E.coli, klebsiella, actinobacillus equuli • CS: pyrexia rare; typically normothermic • Dx • Positive blood culture (takes about 72 hours to get results) • Should recommend 3 cultures but 92% will be positive on the first culture • 60-81% of confirmed septic foals have positive blood cultures

  23. Neonatal Septicemia • Dx • In utero acquired infection • Increased fibrinogen • Neutrophilia • Elevated creatinine • Neonatal foal Sepsis score • Pertinent historical and physical exam findings w CBC and chemistry results (showing organ dysfunction) -> predicts the likelihood of sepsis • Score of >12 correctly predicts sepsis 93% of the time

  24. Neonatal Septicemia • Tx • Antimicrobials • Penicillin and amikacin • Not per os administration • If CNS (septic meningitis) change to 3rd gen cephalosporins, cefataxime, moxalactam) • Immunological support: • Commercial plasma and endoserum • Supportive therapy • Anti-inflammtories, anti-ulcer meds • Fluid therapy: D5W, LRS

  25. Neonatal Septicemia • Complications and Sequelae • Chronic pneumonia (50%) • Ileus, enteritis, colitis, diarrhea (38%) • Joint ill: occurs later after the septicemia seems like it has a good resolution, tx: repeated flushing of joints • Patent urachus or uroabdomen • Septic meningitis: depressed, altered mentation, head pressing, seizures

More Related