Management of Neonatal Maladjustment Syndrome in a Premature Foal

The patient, a 14 hour old Friesian colt, presented to the Cornell University Hospital for Animals Large Animal Medicine Service in May 2013 for generalized weakness and inability to nurse. The colt was born at 316 days gestational age and had been unable to stand and nurse unassisted since birth. Parturition was unobserved and the placenta was complete but edematous with a thick brown exudate. Before presentation to Cornell, the colt received colostrum, intravenous isotonic fluids and plasma, thiamine, Naxcel and Vitamin E/Selenium by the referring veterinarian. According to the owners, the colt had been observed urinating normally and had passed a normal amount of meconium. On presentation, the colt was recumbent and quiet but alert and resistant to handling. Vital parameters were within normal limits apart from evidence of mild dehydration. CBC, Chemistry, and venous blood gas revealed a neutropenia with left shift (200 bands) and mild toxic change, moderate hyperlactatemia, azotemia, and severe hypogylcemia. IgG levels were inadequate at 705 mg/dL and Equine Herpes Virus Type 1 PCR was negative. The colt remained stable with normal mentation for approximately 12 hours in hospital (26 hours of age) but then began to exhibit signs of central neurologic dysfunction including hyper-responsiveness and extensor rigidity. Perinatal hypoxia-ischemia was suspected as the primary differential diagnosis and treatment with neuroprotective agents was initiated. The patient’s neurologic status deteriorated to include tonic seizure activity that was controlled with a constant rate infusion of Midazolam. Decreased respiratory rate caused by depressed central drive resulted in moderate hypercapnea, therefore oral caffeine was administered. This was unsuccessful in increasing the respiratory rate therefore a Doxapram constant rate infusion was instituted, which was successful in maintaining a normal respiratory rate and normocapnea. The Doxapram and Midazolam were discontinued gradually over the following two days with the colt maintaining fairly normal mentation. Nasogastric feeding, systemic antibiotics, gastroprotectants and general supportive care were also provided. The colt was gradually reintroduced into the stall with the mare and discharged to the care of his owners after eight days of hospitalization. Follow-up with the owners reported no difference in comparison of growth and training with his fellow herd-mates and the colt has since been successfully shown and sold