Emergency Neonatal Triage for Sepsis

The transformation from fetus to neonate represents a series of rapid and dramatic physiologic changes during which the placenta is replaced by the lungs as the primary organ of gas exchange. The transition goes smoothly most of the time; however, in human medicine (we do not know in equine medicine), approximately 10% of the time active intervention of a skilled individual or team is necessary to ensure that the newborn receives the appropriate assistance to assume independent existence as quickly as possible. Ideally, whenever a foal is delivered appropriate equipment (Table 1) should be close and easily accessible. These supplies should be routinely checked for completeness, good working order, and expiration dates. A delay in effective resuscitation may occur if someone needs to leave the “scene” during the procedure to obtain an essential piece of equipment. The need for full resuscitation, including chest compressions or medical administration or both, is relatively rare, occurring in humans approximately 1–2 per 1000 live births. Cardiopulmonary cerebral resuscitation in humans has a success rate between 10 and 15%; in veterinary medicine, the success rate is less than 10%. Resuscitation is only the beginning. Owners must realize that the initial event causing respiratory or cardiac arrest, as well as hypoxia (reduction of oxygen supply to tissues) that occurs during arrest, can cause more problems for the foal. Thus, referring a resuscitated foal to an intensive care facility for further evaluation is appropriate. The approach to the management of the sick foal will vary depending on the size of the breeding establishment involved, the economic value of the foal, and environmental, geographic, and seasonal factors. All of these factors should be taken into account when advising each owner of the best intervention to help mitigate any potential issues. The use of “risk categories” for foals is very helpful for veterinarians in determining the stage and speed of intervention. The use of examination forms and foaling charts can be useful as they may guide future decision making and also be useful if the animal is later assessed by another practitioner.