|
| Home | Search | Highlights | Yellow Pages | Contests | Submit URL/Place Ad | Site Map |
| Saving Foals through the Neonatal Intensive Care Unit |
|
| Dr. Gary Magdesian with a foal that was born three weeks premature. |
 |
 |
| (Above) Veterinary
students and Foal Team members assisting Dr. Pusterla (above right).
The foal had a ruptured urachus (fetal structure connecting the
bladder) which caused urine to collect in its abdomen. The urine
contains toxins which affect the heart and other vital structures.
The urine needed to be drained manually until surgery could be performed
to correct the rupture. (Right) After surgical correction and a 14 day stay in the neonatal intensive care unit, the foal was ready to go home. |
The NICU has the facilities and capabilities to address the neonate's special needs including oxygenation, nasogastric feeding, intravenous feeding, IV fluid support, blood pressure support, antibiotic therapy, blood transfusions, surgery and mechanical ventilation when necessary. The unit is state-of-the-art with in-house oxygen lines, blood gas analyzers, hydraulic foal beds, slings and highly-trained technicians that care for the foals.
What makes the neonatal unit unique is its ability to provide assistance with every metabolic and physiological need of the sick foal who may be totally dependent on medical support for its vital functions. The NICU is a highly focused operation because it must be able to address all the foal's physiological needs in a very short time period.
In addition to caring for the foals, the unit provides care for the mothers who are normally admitted with their foals. Their treatment often includes dealing with retained placentas, uterine bleeds and urogenital infections. Mares with foals that are too weak to nurse must be milked by hand to maintain milk production and to provide nutrition for the foals who are fed by stomach tubes.
Caring for sick neonatal foals requires a substantial commitment from
dedicated and talented people. The NICU is currently headed by Drs.
John Madigan and Gary Magdesian, two internationally recognized experts
in neonatal medicine. There are 28 intensive care unit veterinary technicians
that provide critical nursing care for the large animal and neonatal
intensive care units. The NICU also utilizes volunteer help from the
Foal Team, a group of 71 student volunteers who assist the
veterinarians
around the clock in attending to the neonate's unique needs.
 |
| A neonatal foal in the specialized foal box wrapped in a warming blanket called the "bear hug." Neonatal foals do not regulate their body temperature very well. The bear hug blanket provides even warming without the risk of overheating the delicate skin which can occur with the use of heating pads or hot water bottles. |
 |
| (Left to right) Dr. John Madigan, Lucy Whittier and Dr. Gregory Ferraro at the dedication of the Lucy Whittier Neonatal Intensive Care Unit in July 1999. Funds from the Whittier Foundation were used to renovate the neonatal unit, increasing its capacity and efficiency. |
On average, the NICU cares for 45 to 60 foals each year; however, this
past season, thanks to recent renovations in the unit, approximately
70 neonates were admitted with an additional 15 being cared for in the
isolation unit due to problems associated with severe diarrhea. The
most common problems of foals included septicemia, birth asphyxia (hypoxia),
prematurity/dysmaturity, neonatal isoerythrolysis (breakdown of the
foal's red blood cells by maternal antibody), uroperitoneum (ruptured
bladder) and diarrhea.
In 1999, funding provided through the Lucy Whittier Endowment for Equine
Perinatal and Infectious Disease Research allowed for much-needed renovations
at the NICU. Mrs. Whittier is the proprietor of Las Colinas, a very
successful Arabian farm and a long-time client of the VMTH. She established
a $1 million endowment with the Center for Equine Health to show her
appreciation for the dedicated service she has received from the VMTH's
staff over the years. "The teaching hospital," she said, "and
its fine staff of medical specialists and technical personnel have always
provided my horses with the best of care. I want to ensure that they
will carry on that service for others in the future."
The Whittier Foundation's generous support allowed for a complete remodeling and updating of the Neonatal Intensive Care Unit. Two additional mare and foal stalls were added to the unit. The new stalls have adjunct foal boxes which allow for partial separation of the foal from the mare when the foal is critically ill. This allows for intensive management of the foals while they are too weak to stand or nurse. In addition, the unit now has a mobile foal box bed with hydraulic overhead lift devices to aid in the lifting and moving of foals in a safe manner. This bed also allows for raising recumbent foals so that they are off the floor, providing a warmer environment for foals, as well as easier access by the nursing staff. The mobile foal box has proven so successful that another one is currently being constructed for use in the NICU.
Another advantage to the renovated stalls is the close proximity of the mare to the foal. This close proximity makes the mare more comfortable as she can see and nuzzle her foal through a large opening. Prior to the renovation, the foals were housed in pens separate from their mothers who had to stand patiently in nearby stanchions. This added to the stress of both mother and foal. The new large stalls allow the mare free access in a large stall in close proximity to the foal which is sectioned off by a specialized foal bed.
The renovations have also allowed for the installation of monitoring equipment in each stall and large service areas and work spaces for the NICU technicians. The expansion and upgrading of the unit has increased its capacity and improved the standards of care in the management of these critically ill neonates. This modern facility also allows our faculty to provide improved resident and veterinary student training in this vital area of medical care.
In the last five to ten years, equine neonatal medicine has begun to mimic human neonatal medicine. Veterinarians use much of the same equipment, including pulse oximeters, automated fluid pumps, total parenteral nutrition, blood pressure monitoring, ECG monitoring equipment, ultrasound, etc. |
(Below) Damaris ("D") Hochanadel, a neonatal intensive care unit technician, tends to a sick foal. |
 |
|
| (Above left) NICU technician Scott Barber assists a foal in the foal box while the dam looks on from her adjacent stall. The newly renovated stalls allow close contact between the mare and foal which provides a sense of security for both. | |
Recently, neonatal medicine has focused more on intensive monitoring
including perfusion parameters (oxygen delivery to tissues) to minimize
the effects of shock. The newest monitoring tests are designed to assess
if the needs of the foal's tissues are being met (e.g., fluids, oxygen,
nutrients, etc.). These tests include measuring central venous pressure,
blood lactate levels, osmolarity and oncotic pressure. Newest treatment
modalities include the use of pressors and inotropes (drugs used for
cardiovascular support), mannitol for brain disorders including hypoxic
encephalopathy ("dummy foal syndrome" or "maladjustment
syndrome"), and the potential for use of Oxyglobin, a bovine-based
hemoglobin product for treating neonatal isoerthrolysis.
Thanks to the NICU, its talented and specialized staff, its dedicated Foal Team of volunteers, and its state-of-the-art equipment, UC Davis can continue saving foals and fostering research and education. If you have any concerns regarding your newborn foal, the UC Davis NICU can address your needs and, if necessary, provide the comprehensive intensive treatment your foals may require so they can return to frolicking with their mothers and herdmates.
|
|
(return to top) |
The NICU was founded in the early 1980s by the NICU's co-head
Dr. John Madigan. Dr. Madigan was one of the pioneering
veterinarians in the field of equine neonatal intensive care.
Author of the text, "Manual of Equine Neonatal Medicine,"
he remains a leading authority in the field of neonatal care.
He modeled the unit after human neonatal hospitals, providing
for much of the same expertise offered by those hospitals.
Along with veterinarians completing equine medicine residencies,
intensive care unit technicians, UC Davis veterinary students
and UC Davis Foal Team volunteers, Dr. Madigan improved the
survival rates of otherwise critically ill foals.