Corneal ulcers and entropion
Recumbent foals are at an increased risk of developing corneal ulcers and entropion [ 2 ] . Lethargic and sick foals may not have the strong blink reflexes needed to protect their eyes . Daily monitoring will include staining the eyes with fluorescein , followed by close inspection for corneal lesions . The administration of sterile ophthalmic lubricants several times a day acts as a protectant and preventative treatment . Ulcers may form secondary to entropion , so careful monitoring and intervention may be required .
Feeding and weight gain
On average , a healthy Thoroughbred neonate will gain approximately 1 – 1.5 kg in weight per day . Whether they are recumbent or mobile , foals should be weighed daily to monitor their growth . The same scales should be used each time to ensure consistency .
Healthy foals ingest up to 25 % of their body weight in milk per day . Feeding time for the recumbent foal should not be rushed . If there is no evidence of ileus , and faecal output is normal , they can be fed if they can maintain their position in sternal recumbency , are mentally alert , and have a consistently strong swallow reflex . Whether the foal is bottle-fed or bowl-fed , care must be taken to avoid milk aspiration . To prevent this , offer the milk in a manner that encourages the foal to maintain a posture where its nose is positioned below its poll . This prevents free-flowing milk from inadvertently entering the trachea . Inspect bottle teats to make sure the milk does not freely exit the teat . If possible , it is safer to teach the neonate to drink from a bowl until it can go back to nursing from the mare .
It is common for the recumbent neonate to be intolerant to normal milk volumes and subsequently develop ileus . If supplementary parenteral nutrition is introduced , it enables the gut to rest and weight gain can resume . Many foals thrive on parenteral nutrition , as evidenced by their improved body condition scores and coat condition .
Physiotherapy
Foals that are recumbent for a sustained period will be prone to distal limb contractures , pressure-induced decubitus ulcers and muscle wasting . Performing passive range of movement exercises with the fetlock , carpal and tarsal joints will prevent contractures and improve flexibility . Keeping within normal physiological ranges of movement ensures there is no added strain on the foal ' s undeveloped joints . The circulation can be stimulated by regularly shifting the pressure from specific parts of the body on to other areas and by massaging the skin and muscles .
When the foal progresses to maintaining a weightbearing position , passive range of movement exercises can continue , and these will reinforce the foal ' s developing neural pathways , acclimatising it to normal standing behaviours .
Mare bonding and human interaction
Every effort must be made to nurture and sustain a strong bond between the mare and her foal . It is easy to interfere with that relationship when recumbent foals are separated from the mare and surrounded by a plethora of IV lines and infusion pumps . Equally , too much human intervention can make the foal more dependent on the carer and harder to successfully reintroduce back to the mare when its health improves .
If possible , allow time for normal mare – foal interaction , preferably in a quiet and undisturbed setting . When the mare and foal are confined in a stable for days on end , normal behaviours can be encouraged with some effort . Taking the pair outside for some grazing and sunshine can help to prevent vices in the mare that could impact on the provision of treatment ( Figure 5 ).
With many recumbent foals requiring intensive nursing care , an indwelling nasogastric tube ( NGT ) will usually be in place . Feeding via an enteral gravity feeding bag ( Kangaroo , Covidien ) stimulates the natural opening of the cardiac sphincter , allowing a natural and gentler ingress of milk . The flow by gravity is not forced , so it is better tolerated and less likely to cause colic compared with syringe-feeding .
Prior to every feed , the NGT and stomach will need to be inspected for the presence of nasogastric reflux , by withdrawing any residual fluid with a syringe . Before commencing feeding , the NGT must be checked to ensure it is secured at the nose , in its original position .
Figure 5 . A mare and foal that have been taken outside for some fresh air and sunshine , to encourage bonding and normal equine behaviours .
32 Veterinary Nursing Journal