Equine Medicine Final > Septic neonates > Flashcards

Septic neonates Flashcards

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1
Q

Normal gestation

A
  • 320-360 days
  • Average is 340 days
  • Mare will typically foal close to the same date with each foal
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2
Q

What can cause gestation in mares to be longer?

A
  • Mares carry colts
  • Mares bred early
  • Older mares
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3
Q

Last 48 hours of gestation

A
  • Development is critical in foals in the last 48 hours
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4
Q

What signals readiness for birth?

A
  • The HPA axis of the foal

- This is why you cannot induce the mare

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5
Q

What influences organ development in the foal?

A
  • Steroid influence

- Another reason why induction of parturition not recommended

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6
Q

What are the three stages of fetal maturation development?

A
  • Premature
  • “Twilight”
  • “Ready for birth”
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7
Q

Premature foals

A
  • generally <310-320 days
  • Immature adrenal axis
  • Poor or no response to ACTH
  • Low white cell count
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8
Q

“Twilight foals”

A
  • 320-330 days
  • Intermediate hormonal development
  • Intermediate WBC counts
  • Intermediate ACTH responsiveness
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9
Q

“Ready for birth” foal

A
  • Mature
  • Fully active and responsive adrenal axis
  • Normal WBC count
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10
Q

How can you tell is a mare is close to parturition?

A
  • Tail head relaxation
  • Relaxation of the perineal area
  • Relaxation of the pelvis
  • Softening of cervix
  • Development of mammary glands
  • “waxing”
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11
Q

Milk electrolytes close to parturition

A
  • Calcium >10mmol/L
  • Potassium >35 mmol/L
  • Sodium <30 mmol/L
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12
Q

Parturition stage 1 length of time

A
  • 1-4 hours
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13
Q

Parturition Stage 1 neonatal position

A
  • I think it rotates so that the head is down with both legs forward
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14
Q

Parturition Stage 1 “Pseudo colic”

A
  • Flehman response
  • Pawing
  • Looking at flank
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15
Q

Stage 2 parturition

A
  • Rupture of chorioallantois or breaking water

- Expulsion of the foal

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16
Q

How long should Stage 2 last?

A
  • Up to 45 minutes, but average is 20 minutes

- NEED to set a timer; if it takes longer than this, there’s a problem

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17
Q

Stage 3 parturition

A
  • Expulsion of fetal membranes
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18
Q

How long should stage 3 parturition take?

A
  • No longer than 3 hours
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19
Q

What happens if stage 3 takes longer than 3 hours?

A
  • Retained
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20
Q

What are risk factors for retained placenta or longer time?

A
  • Dystocia or C-section
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21
Q

What can happen if fetal membranes stay in too long?

A
  • Mare can get extremely toxic

- Probably put them on antibiotics

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22
Q

What’s normal in the first 5 minutes after birth?

A
  • life head, alert, sternal, suckle, reflex
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23
Q

When should the foal be standing by?

A
  • 1-2 hours
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24
Q

When should the foal be nursing by?

A
  • 2-4 hours
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25
When should a feeding pattern be established?
- 12 hours | - Usually nursing 7-10 times an hour
26
What is the HR of a foal at birth?
- 60-80 BPM
27
What is the HR of a foal 1 hour after birth?
- Increases to 100 at 1 hour
28
What is the HR of a foal by 12 hours after birth?
- 80-120 bpm by 12 hours
29
When should you do a physical exam of a foal?
- Between 12 and 14 hours of age
30
What should you assess on a physical exam of a foal? (3 very important factors)
- Mental status of the foal - Attachment to the mare - Nursing well
31
Neurologic status of a foal
- Awake - Somnolent - Stuporous - Comatose - Seizures - Focal - Generalized: interval, duration, status epilepticus
32
Mucous membranes on a foal
- Pale, cyanotic, icteric, petechiations, ecchymoses
33
What does it suggest if a newborn foal has icteric mucous membranes?
- Herpesvirus
34
Where can you assess mucous membranes of a foal for petechia and echymosis?***
- vulva - Ears - Gums CHECK ALL OF THESE PLACES
35
Respiratory system exam on a foal
- Auscultation - Palpation for rib fractures - Ultrasound - Radiographs
36
Cardiovascular system exam on a foal
- Mucous membrane color and refill - Auscultation - Heart rate - Murmur (PDA up to 7 days) - Arrhythmia - Pulse quality - MAP >60 mmHg
37
What should the 1 minute post foaling temp be?
- 99-100F
38
What should the 12 hour post foaling temperature be?
- 100-102F
39
When should you suspect a problem for foaling temperature at 12 hours post foaling?
- Below 100 or above 102
40
Umbilicus examination
- Palpate for abnormalities - Dip with dilute chlorhexidine - Ultrasound
41
Ultrasound findings of the umbilicus
- Stump <2 cm - Vessels <0.5 cm - Urachus (don't want to see it patent)
42
Potential problems with umbilicus
- Infection - Hernia - Patent urachus - Urachal rupture
43
Urinary tract exam in foals
- intact bladder - Can rupture during parturition - Colts more likely than filly
44
Why are colts more likely to have a bladder rupture during parturition?
- Narrow pelvis | - Often have a full bladder when born, and colts have a big bladder going through their narrower pelvis
45
When should colts typically urinate by?
- 6-8 hours of age
46
When should fillies typically urinate by?
- 12-14 hours of age | - Often expelled as it was born
47
GI tract exam in a foal
- Meconium (do they have tiny black feces?) - Diarrhea - Abdominal distension
48
When should meconium pass by?
- 12-14 hours after parturition
49
Reproductive tract exam in a foal
- Scrotal hernia - Inguinal hernia - Congenital vs ruptured tunic
50
Ophthalmology exam on a foal - why important?
- Septic foals often have a problem with the eyes
51
Ophthalmology exam on a foal possible findings
- Entropion (dehydration) - Corneal ulcers - Periocular trauma - Uveitis - Congenital - Cataracts**
52
Musculoskeletal exam findings on a foal
- Flexural deformities - Joint effusion - always palpate - Angular limb deformities
53
Immaturity/dysmaturity signs
- Floppy ears - Tendon laxity - SIlky hair coat (if immature, premature, or dysmature) - Carpal and tarsal bones lack of ossification
54
What does prognosis depend on carpal and tarsal bone ossification?
- How well ossified they are | - She will often take an x-ray pretty quickly to get a sense of prognosis
55
Dysmature foal
- Dysmature if it's 340 days or older and has characteristics of floppy ears
56
Normal PCV for a foal
- 34-44% at birth
57
What happens to the PCV of a foal over the first week?
- Decreases over the first week
58
What is suggested if the PCV of a foal is >45% when born?
- May indicate in utero hypoxia
59
What are two differentials if a foal is anemic?
- Neonatal isoerythrolysis | - blood loss (when foals are born, they can bleed for awhile from the umbilical site)
60
Normal TP at birth
- Less than 5.0g/dL
61
What should happen to TP after birth?
- Increases with passive immunity
62
What is suggested if TP and globulins are high at birth?
- In utero infection
63
What is suggested if the TP is low at 12-14 hrs after birth?
- Failure of passive transfer | - Protein loss through GI or kidney
64
Hematology of a foal with in utero infection?
- Leukocytosis - Neutrophilia/neutropenia - Band neutrophils - Lymphopenia - Fibrinogen should normally be less than 200g/dL
65
What is suggested if fibrinogen is greater than 200g/dL?
- In utero infection
66
Biochemistry panel "normal" elevations
- Alkaline phosphatase can be normal up to 2835 for a few weeks - Bilirubin may go as high as 5.5mg/dL due to lysis of foal erythrocytes in first week of life - Phosphorus elevation (growing)
67
Biochemistry panel "abnormal" elevations
- Creatinine - Elevated BUN - Lactate
68
What is suggested if the foal has an elevation in creatinine?
- Consider placental insufficiency
69
What is suggested if the foal has an elevation in BUN?
- Consider protein catabolism from starvation in utero | - Mare had colitis or something
70
What is suggested if the foal has an elevation in lactate?
- Watch trend - Problems with perfusion and utilization - Not too concerned if high at birth but goes down
71
What is the most common problem in neonates?
- Neonatal septicemia
72
Morbidity rate of neonatal septicemia
- High
73
What factors are key to success of treating neonatal septicemia?
- Early ID and management
74
Risk factors for neonatal septicemia
- FPT or partial FPT - Perinatal stress - In utero hypoxia - Prematurity - Poor management: unsanitary conditions, poor ventilation, exposure to primary pathogens
75
Neonatal risk factors for septicemia
- Stress - Prematurity/dysmaturity - Prolonged gestation - Twin gestation - Meconium staining - FPT - Perinatal asphyxia syndrome
76
Maternal risk factors for septicemia
- Old age (colostrum not good) - Illness - Colic - Loss of colostrum - Stress - Prolonged gestation - Dystocia - Poor nutritional status
77
In utero infection CBC findings
- Leukocytosis and high fibrinogen at <24 hours | - Some foals born from dams with placentitis may not be septic but will have elevated WBC count for 2-4 days
78
In utero infection signs
- +/- uveitis - changes on CBC - May be slightly premature or thin as a result of inflammatory cytokines (IL-1, IL-6, TNF)
79
What is usually the etiology of in utero infections?
- Bacterial placentitis usually the etiology
80
Treatment of SIRS of Sepsis in the fetus
- Influence development of SIRS in the fetus by treatment of the mare and placental inflammation - Antimicrobials - Pentoxyfylline - NSAIDs (flunixin meglumine or Firocoxib) - Altenogest - Antioxidants (Vitamin E)
81
Pentoxyfylline
- Drug used for laminitis - Makes red cells more flexible - Decrease production of IL6, IL1, TNF
82
Altenogest function
- Decrease myometrial response | - Progesterone
83
What two events must have occurred for a postpartum infection to have occurred?
- Exposure to microbes | - Defense response inadequate
84
Environmental risk factors for postpartum infections
- Nosocomial infections - influence of antimicrobial agents altering flora - Stall vs pasture - less incidence of diarrhea, same incidence of septicemia
85
immune risk factors for postpartum infections
- Failure of passive transfer
86
Organ dysfunction risk factors for postpartum infection
- Usually effect of perinatal asphyxia - Weakness - Abnormal intestinal motility - Inadequate or abnormal nutrition - Red bag (??)
87
Prevention of exposure to environmental pathogens
- Good management is most important - Clean stalls - Hygiene around foaling time - Cleaning mare's udder and perineal regions - Umbilical care
88
Colostral management
- Checking mare to determine if adequate mammary development - Testing colostrum - IgG evaluation in foal
89
What should specific gravity of colostrum be?
- >1.060
90
When should you perform IgG eval in a foal?
12-14 hours of age
91
What is considered adequate transfer of immunity?
- >800 or >400 | - Everyone agrees that <400 is inadequate
92
What influences production of colostrum?
- Produced under hormonal influence last 2-4 weeks of gestation
93
What does colostrum contain?
- Contains immunoglobulins (primarily IgG type) concentrated from mare's blood as well as other factors important in immunity
94
Characteristics of colostrum
- thick, yellow sticky
95
When is colostrum replaced by milk?
- 12-24 hours after foaling
96
Special cells to absorb IgG in the neonate
- Neonate has specialized cells in the small intestine to absorb large molecules
97
How do neonates absorb antibodies?
- pinocytosis | - Not specific
98
When are the specialized cells replaced?
- by 36 hours of life
99
When is the peak of colostrum absorption?
- Shortly after initial ingestion | - Usually around 2 hours of age
100
When is the ability to absorb colostrum decreased?
- 6-8 hours of age
101
When is the ability to absorb colostrum gone?
- 18 hours
102
What is optimum amount of colostrum to absorb?
2-4 L
103
Colostrum replacement
- No replacement better than good quality, tsted colostrum
104
Colostrum banks: Which antibodies does colostrum from a bank usually test negative for? Which viral disease is screened out as well?
- Tested negative for Aa and Qa antibodies against a bank of RBCs - From EIA negative donors
105
Oral supplements as substitute for oral colostrum
- Rarely achieve sufficient plasma levels of IgG
106
When does neonatal sepsis usually occur?
- Usually <7 days of age | - Can be later
107
Pathogenesis of sepsis
- Bacterial infection | - Can progress to Systemic Inflammatory Response Syndrome --> sepsis --> septic shock --> MODS --> DEATH
108
What do older foals tend to get instead of systemic sepsis?
- Localized infections
109
Onset of sepsis
- Variable but typically <7 days
110
When does acquired post natal sepsis usually occur?
- Typically 3-4 days of age | - Can see as early as 24 hours of age
111
What gram stain are most common pathogens in neonatal sepsis?
- Gram negative | - Can be mixed
112
When do Actinobacillus sepsis infections usually occur?
- 24-48 hours old
113
Most common Gram negative pathogens
- E. coli | - Klebsiella
114
Most common Gram positive pathogens
- Streptococcus - Staphylococcus - Less common overall
115
Recognition of sepsis in neonate early signs
- Septic until proven otherwise - Early signs are weakness, somnolence, lethargy, decreased suckle - Petechiae and microvascular injury - Discolored mucous membranes due to poor microvascular flow - Icterus as endotoxin impairs bile flow in the liver - Hypotension/poor arterial pulses/cold peripheral skin
116
What is one of the most important signs of sepsis?
- DECREASED SUCKLE
117
What are five quick things to indicate of a foal isn't suckling or dehydrated?
- Udder distension/streaming milk - CRT - Entropion - Urine specific gravity (mare's milk and colostrom often have low USG so should be <1.008 in the first 48-72 hours) - Hypoglycemia
118
History of mare that would suggest neonatal sepsis
- Placentitis - Vulvar discharge - Dystocia - Prematurity
119
CBC results in neonatal sepsis
- Leukopenia/neutropenia - Left shift - Toxic changes
120
Chemistry results in neonatal sepsis
- Hypoglycemia | - Elevated lactate
121
Blood culture results
- Isolation of microorganisms - 26-28% in some NICU's - New study showed healthy foals can be bacteremic in the first 24-48 hours of life
122
Interpretation of positive blood culture?
- Iffy | - If they're showing signs of sepsis, they are probably septic
123
Clinical findings of neonatal sepsis
- Fever/hypothermia - Petechiae - Scleral injection - Obtundation/coma/seizures - Anterior uveitis - Diarrhea - Pneumonia - Swollen joints
124
Diagnosis of neonatal sepsis
- history - Clinical signs - Blood culture - Radiographs - Ultrasound - Sepsis score - Joint tap
125
Sepsis score categories
- History (peripartum events) - Physical exam (signs of infection; foal's condition) - CBC (markers of sepsis) - Chemistry panel - Indicative of organ or systemic disease - Helps understand parameters that indicate sepsis - Helps predict likelihood of sepsis
126
What score on the sepsis score usually correctly predicts sepsis?
- Score of 12 or more | - not 100% by any means
127
Initial stabilization of septic neonates
- Heat (prevent hypothermia) - Respiratory support: nasal oxygen, caffeine - Eye care: correct entropion - Fluid therapy: over the wire catheter (blood culture, give glucose, administer plasma) - Control seizures with diazepam
128
Antimicrobial selection in septic neonates
- Broad spectrum combo - Penicillin (Gram positive) + aminoglycoside (gram negative) - Do not use nephrotoxic drugs if birth asphyxia suspected - Ceftiofur alone or in combination - Reserve advanced antimicrobial drugs (e.g. iminpenim) for severe sepsis and susceptibility known
129
Monitoring for nephrotoxic abx
- If creatinine is WNL you can use, but make sure you monitor it over time - Pay attention to hydration and albumin concentrations
130
Adverse effects of antimicrobials
- Avoid nephrotoxic drugs - Long term can alter normal microbiome - Predispose to fungal overgrowth (Candida) - Usually seen in very sick weak foals, not on normal nutrition
131
Nutrition of septic foals
- Enteral if possible - If possible birth asphyxia consider parenteral nutrition - Pass small bore nasogastric tube to be left in place
132
What % of body weight to healthy foals eat?
- up to 25%
133
What % of body weight should be given to septic foal initially?
- 10% of amount initially or less
134
Other nursing care considerations when feeding a septic foal
- Make sure in sternal - Frequent feedings q2 hours - Sick foals have a decreased RER
135
Treatment summary for septic foal
- Supportive care - Fluid therapy - +/- pressor - +/- physiologic doses of corticosteroids - Plasma - Oxygen insufflation - Antimicrobials - Nutritional support
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