La lattatemia nel puledro neonato sottoposto a terapia intensiva

Admission blood lactate concentration has been shown to be a useful indicator of disease severity in human medicine and numerous studies have associated hyperlactatemia with patients at high risk of death who should be treated aggressively regardless of the cause of the lactate generation. The degree and duration of hyperlactacidaemia also have been correlated with the subsequent development of organ failure. Similarly, in a small number of studies about equine colic, blood lactate concentration has been investigated as a useful prognostic variable . In neonatal foals blood lactate was studied first by Magdesian (2003) who described venous blood lactate concentration in 14 normal foals during the initial 48 hours post-partum. A preliminary study about lactate concentration in foals presenting to a neonatal intensive care unit reported that surviving foals had earlier lactate clearance. The measurement of blood lactate concentration is traditionally available with a wet chemistry laboratory method or with blood-gas analyzers, for clinicians working at university or large private hospital. But this methods may not be easily accessible to many practitioners in field conditions. Several relatively inexpensive, easy to use and rapid pocket size monitors to measure lactate concentration have been validated in human patients and athletes. None of these portable lactate analyzer have been evaluated in clinically normal neonatal foals or in foals referred to a neonatal intensive care unit. The aims of this study were to validate the Lactate Scout analyzer in neonatal foals, investigating the correlation between lactate concentration in whole blood measured with the portable monitor and measured in plasma with the reference laboratory analyzer. The effect of hematocrit (Hct) on the accuracy of Lactate Scout was also evaluated. Further, we determined the utility of venous lactate measurement in critically-ill foals, describing lactate values in the most frequent neonatal pathologies, evaluating serial blood lactate measurements during hospitalization and investigating its prognostic value. The study also describes normal range for lactate in healthy neonatal foals during the first 72 hours of life

Dystocia in the Standardbred Mare: A Retrospective Study from 2004 to 2020

Simple Summary In the equine species, dystocia, any impediment to normal parturition, is not frequent, but when it occurs it can quickly evolve into a critical situation. The aim of this study was to retrospectively describe the incidence, causes, categories of dystocia severity, resolution procedures and postpartum complications in Standardbred mares hospitalized in a Veterinary Teaching Hospital and evaluate the effects of dystocia on the clinical and blood parameters of their foals. In normal pregnancy, the incidence of dystocia was 4.9%. Stage II appeared significantly longer in dystocic delivery, and the occurrences of postpartum complications in mares and onset of neonatal disease in foals were more frequent after dystocia. This study also investigated, for the first time, foaling difficulty, dividing all dystocic deliveries into mild, moderate and severe dystocia. Therefore, even a short but physiologically abnormal delivery can pose a risk to the life of the newborn and determine complications in the mare. Dystocia as a prolonged stage II parturition (>30 min) was associated with a higher risk of complications. The hypothesis of the study was that any type of dystocia could affect the foal's health, even when the stage II was <30 min. Clinical reports on 222 Standardbred mares and their foals hospitalized at the Veterinary Teaching Hospital of the University of Bologna from 2004 to 2020 were reviewed. Mares were divided into the Eutocia Group (165, eutocic delivery) and the Dystocia Group (57, dystocic delivery). The incidence of dystocia was 4.9%. Stage II was longer in the Dystocia Group (median 20 min) than in the Eutocia Group (median 12 min). All occurrences of dystocia were retrospectively classified into three categories of severity: mild, moderate and severe dystocia. The occurrence of postpartum complications in mares and neonatal diseases and failure of passive transfer of immunity in foals was higher in the Dystocia Group. Foal venous lactatemia and serum creatine kinase were significantly higher in the Dystocia Group (median 3.9 mmol/L; 262 UI/L respectively) than in the Eutocia Group (median 3.1 mmol/L; 187 UI/L respectively). The APGAR score was lower in the Dystocia Group (median 8) than in the Eutocia Group (median 10) and significantly lower in severe dystocia (median 3). The duration of stage II should not be considered the only parameter of dystocia in mares: even a rapid resolution of dystocia could pose health risks to the foal and the mare

Rhabdomyolysis and Acute Renal Failure Associated with Oxytetracycline Administration in Two Neonatal Foals Affected by Flexural Limb Deformity

Oxytetracycline (OTC) administration has become a frequent practice in equine neonatology for the treatment of flexural limb deformity. The cause of this condition remains unclear but clinical studies revealed that following IV administration of OTC a relaxation of the metacarpophalangeal joint occurs in foals affected by flexural deformity. Studies concluded that OTC administration in neonatal foals did not adversely affect the kidneys. Other adverse effects of OTC have never been reported. This report presents two cases with different outcomes of 3-day-old foals which presented acute collapse and progressive depression after OTC administration. The clinical aspects, the increased activity of serum enzymes indicative of muscular damage, the presence of myoglobin in urine were clear diagnostic indicators of severe rhabdomyolysis, and the gross and histological findings confirmed a myopathy associated with renal damage in one case. Adverse effects on the musculoskeletal and urinary systems in healthy foals were first reported and were probably associated with multiple doses administered to foals less than 24\u201348 h old and/or at dosing intervals less than 24\u201348 h. The risk of development of rhabdomyolysis and nephrotoxicity in neonatal foals treated with OTC for flexural deformity from now on should be considered

Fetal Congenital Diaphragmatic Hernia and Hydramnios in a Quarter Horse Mare

open6noHydramnios is an excessive accumulation of fluid within the amniotic compartment. It is a rare condition in mares, often associated with fetal anomalies. Hydrops of fetal membranes predisposes to the rupture of the prepubic tendon, and many authors suggest the induction of parturition to preserve mare’s reproductive career. This report presents the case of a 15-year-old multiparous Quarter Horse mare, referred at 268 days of gestation for suspected hydrops. Repeated ultrasonographic exams confirmed an increase in the depth of the amniotic fluid and reduced fetal viability. During the hospitalization, the mare developed a partial rupture of the prepubic tendon. In this case, a conservative approach was elected, and the mare was treated with nonsteroidal antiinflammatory drugs (NSAIDs) and an abdominal support bandage. At 327 days of gestation, the mare gave birth to a foal with APGAR score 1. The resuscitation attempt was unsuccessful, and the foal died immediately. A post-mortem examination diagnosed a congenital diaphragmatic hernia (CDH) with pleuroperitoneal diaphragmatic eventration.openLanci, Aliai; Ingallinesi, Martina; Morini, Maria; Freccero, Francesca; Castagnetti, Carolina; Mariella, JoleLanci, Aliai; Ingallinesi, Martina; Morini, Maria; Freccero, Francesca; Castagnetti, Carolina; Mariella, Jol

High-Risk Pregnancy Is Associated With Increased Alpha-Fetoprotein Concentrations in the Amniotic Fluid and Foal Plasma

This study aimed to determine alpha-fetoprotein (AFP) concentrations in amniotic fluid, plasma of mares and respective foals: carrying normal pregnancies and delivering healthy foals (n = 20; Group 1); carrying apparently normal pregnancies and delivering sick foals (n = 15; Group 2); carrying high-risk pregnancies and delivering sick foals (n = 14; Group 3). High-risk pregnancy was defined by a history of premature udder development/lactation or increased of the combined thickness of the uterus and placenta, or vulvar discharge and/or mares' systemic illness. Sick foals were affected by neonatal encephalopathy, sepsis, prematurity/dysmaturity, or hypoxic-ischemic encephalopathy. Based on histological examination of the chorioallantois, AFP trend was analyzed in pregnancies with pathologic (PFM) and normal fetal membranes (NFM). Concentrations of AFP were measured using a commercially available immunoassay previously validated for horses. Mares' plasma AFP did not change during the last 15-20 days of pregnancy in the three groups, and there was no difference among them. Amniotic fluid AFP was higher in Group 3 (P = .014). Foals' plasma AFP concentration was higher from birth to 72hours in foals of Group 2 and 3 than in healthy ones, and foals of Group 3 had the highest value. The strong association (r = 0.84; P < .0001) between AFP in amniotic fluid and foals' plasma at birth is likely due to the presence of AFP in fetal urine. AFP was higher in pregnancy with PFM than with NFM in mare's plasma at admission (P = .031), amniotic fluid (P = .004), foal's plasma at birth (P = .002), at 24 (P = .005) and at 72 hours of life (P = .004). AFP is higher in pregnancy with histopathological lesions of the chorioallantois providing the evidence of the differences between pregnancy with a normal placental barrier and the more compromised ones. The increased AFP concentration in the amniotic fluid and plasma of high-risk foals suggests upregulation

Peripartum findings and blood gas analysis in newborn foals born after spontaneous or induced parturition

Induction of parturition in horses is still not well accepted due to the potential peripartum complications for mares and newborn foals. We assessed differences after spontaneous and induced parturition with low doses of oxytocin (OX) in 1) incidence of peripartum complications in mares; 2) viability, behavioral, physical, and venous blood gas analyses in foals. In this study 61 mares were included; 45/61 were enrolled in the spontaneous foaling group (SF) and 16/61 in the induced foaling group (IF). In the IF group, when the calcium in mammary secretion reached concentrations of !250 ppm, mares received a single injection of 2.5 IU of oxytocin IV once a day until foaling. Mares’ breed, age, parity, gestational and stage II length, and peripartum complications were recorded. Foal maturity, vital (Apgar score), behavioral and physical parameters were assessed at birth, and the foal clinical condition was monitored for one week. A jugular venous blood sample was collected at birth for blood gas analysis, acid-base status, and lactate assessment. The median gestational length was within the reference interval in all the mares included and did not differ between the two groups. No statistical differences in the II stage length nor in incidence of peri- partum complications were observed between the two groups. All the foals were born alive and showed no signs of prematurity/dysmaturity. No statistical differ- ences were found in foal viability between the two groups. Time to stand and nurse from the mare, and body temperature were significantly higher in the IF compared to the SF group. Venous blood pH, SO2% and BE were lower, while pCO2 and lactate were higher in the IF than in the SF group. All the foals in both groups remained clinically healthy during the observation period. In conclusion, at term induction of parturition with a low dose of oxytocin does not have adverse effects on peripartum in mares. Our findings suggest that at term induced foals suffer slightly greater, but not clinically significant, hypoxia, hypercapnia and acidosis than spontaneously delivered foals

Macroscopic characteristics of the umbilical cord in Standardbred, Thoroughbred and Warmblood horses

The umbilical cord (UC), the connection between mother and fetus via the umbilical vessels, carries nutrients and oxygenated blood to the fetus through the umbilical vein and removes deoxygenated blood and waste products via the umbilical arteries. It is designed to protect blood flow to the fetus during pregnancy. In equine medicine, only a few studies have described the UC, and most of these involved Thoroughbreds. The present study describes and compares the macroscopic features of the equine umbilical cord in three different breeds and in relation to the foal's gender. In addition, a possible correlation between UC features and maternal and perinatal factors is investigated. One hundred and twenty four healthy mares with normal pregnancies were enrolled in the study and were divided into three groups according to their breed: 70 Standardbreds (STB), 38 Thoroughbreds (THB) and 16 Warmbloods (WAB). The following data were recorded: mare's age and parity, gestation length, placental weight, presence of fetal membrane alterations, UC length and number of coils in the amniotic and allantoic portions, and the Umbilical Coiling Index (UCI), which is the ratio between total coils and total UC length. The UCI has not been investigated previously in veterinary medicine. Furthermore, immediately after foaling, APGAR score, foal's weight and sex were recorded. All the STB and WAB were housed in Italy and the THB were housed in New Zealand. Mares\ue2\u80\u99 mean age was higher in WAB than in THB and STB; the latter had a significantly shorter gestation length. The foal's weight was positively correlated with placental weight in all breeds; and in STB, foal weight was positively related to parity and gestation length. Mean total UC length was comparable to previous reports in THB, STB and WAB. The lengths of the two UC portions were statistically different between STB and THB, where the amniotic portion was longer than the allantoic one. In each breed, total UC length was correlated with total number of coils (THB and STB = 5 \uc2\ub1 1; WAB = 6 \uc2\ub1 1), the UC amniotic length was positively correlated with the number of amniotic coils and the allantoic length was positively correlated with the number of allantoic coils. The UCI values were 0.09 in STB and THB and 0.1 in WAB. This study provides reference values for UCI that could be included in the gross placental evaluation if its clinical importance were demonstrated

Heterologous Wharton's Jelly Derived Mesenchymal Stem Cells Application on a Large Chronic Skin Wound in a 6-Month-Old Filly

A complex feedback of growth factors, secreted by a variety of cell types, is responsible for the mediation of skin healing. Despite the recent advances in wound healing management, this fails up to 50% and skin wounds can still be considered one of the main causes of morbidity, both in human and veterinary medicine. Regenerative medicine, involving mesenchymal stromal cells (MSCs), is nowadays a promising solution for skin wound healing. Indeed, MSCs are involved in the modulation of the inflammatory local response and cell replacing, by a paracrine mode of action. Local application of equine umbilical cord Wharton's jelly MSCs (WJMSCS) was carried out in a 6-months-old filly with a non-healing skin wound. Heterologous WJMSCs were applied four times using a carboxymethylcellulose (CMC) gel, produced dissolving CMC in autologous plasma. At first application the mean wound area was 7.28 ± 0.2 cm2. Four days after the last application of WJMSCs, the mean wound area was 1.90 ± 0.03 cm2, and the wound regression rate was +74%. No local or systemic side effects were registered after WJMSCs application and no evident exuberant scar was observed after wound healing. At discharge, the mean wound area was 0.38 ± 0.01 cm2 and the total regression rate was +80%. Five days later, the wound was completely healed. In the present clinical case report, the use of WJMSCs led to promising clinical results, paving the way for possible future applications in the treatment of chronic wounds in horses

Anti-inflammatory Drugs in Equine Neonatal Medicine. Part I: Nonsteroidal Anti-inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the class of drugs most commonly used in equine medicine. This article reviews the literature on the different NSAIDs used in equine neonatology: flunixin meglumine, phenylbutazone, ibuprofen, ketoprofen, meloxicam, and firocoxib. These drugs are routinely used in equine adults, but in neonatal foals, the risk of side effects should be carefully evaluated. Many of the studies on NSAID pharmacokinetics in neonatal foals have been performed on healthy animals, and more information is needed to determine the appropriate dosage in the compromised equine neonate. The review highlights the lack of specific NSAID dosages for compromised foals and emphasizes the risk of side effects in the neonate

Diagnosis, Treatment, Surgical Management, and Outcome of Septic Arthritis of Tarsocrural Joint in 16 Foals

This article describes diagnosis, treatment, surgical management, and outcome in 16 foals (mean age 7 days of life) affected by confirmed tarsocrural septic arthritis. The chosen therapy was lavage of the synovial cavity performed arthroscopically, once or twice due to recurrence of clinical signs. Information recorded included signalment, history, a complete clinical evaluation, grade of lameness, hematology, biochemistry, serum immunoglobulin G concentration, bone infection radiological findings, cytology and culture of the synovial fluid, treatment, and outcome. Eleven of the foals were males (69%), and five were females (31%). Sepsis affected the right tarsocrural joint in three foals (19%) and the left one in seven foals (44%). Six foals had both hocks affected (37%). In 12 foals (75%), the infection was successfully resolved, and a single intervention was sufficient to have remission of symptoms and resolution of infection. Arthroscopic lavage was repeated in four of 16 foals (25%); five /16 foals (31%) had two joints involved, and the arthroscopic lavage was repeated for all joints. Although the actual literature describes poor possibilities to explore joints in the foal, in this case, it was possible to visualize the inner structures, correctly ascertain and grade the intra-articular damage resulting from infection, and the presence of organic materials inside the joint space. Moreover, what is worth noting is that it was possible to detect and remove fibrin clots thought to be responsible for hiding bacteria and carrying on the infective and inflammatory status