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marefoal_clipartA 10 hour-old thoroughbred filly foal was examined because of diarrhoea, weakness and lethargy. She had an uneventful birth, she stood soon after birth and suckled from the mare within an appropriate amount of time. However, the mare had started running milk from her udder 10 days prior to foaling. Therefore, by the time the foal was born, all the colostrum had run out of the udder so the foal did not receive any.

The owners of this foal were very observant and very proactive. They called their vet before this foal’s condition began to deteriorate too much. Early intervention is the key to treating any illness, and this is never more true than when it comes to treating foals. The foal was placed on a course of antibiotics, but most importantly, she was administered a litre of plasma. She was not dehydrated, so more fluids were not deemed necessary. She still had an appetite, so as long as she continued to drink milk adequately, and the volume of diarrhoea produced did not become excessive, hopefully she would be able to remain adequately hydrated by her own efforts.

There are many different causes of diarrhoea in the newborn foal, some of which are infectious (caused by bacteria) and some of which are due to damage to the intestines during the birthing process. It is important to determine the cause of diarrhoea. However, this can take up to several days, and diarrhoea can be become severe and life-threatening within a matter of hours. Therefore, this foal was administered antibiotics to treat any potential infectious cause of diarrhoea before the actual cause was known. The antibiotics used were broad spectrum, which means they have activity against a wide range of bacteria, as the exact cause of the diarrhoea was not known. A swab of a sample of diarrhoea was taken. Ideally the sample would be sent to the laboratory immediately to be cultured, in order to identify a possible cause of the diarrhoea. However, this foal was seen on a Sunday, when the laboratory is closed, and the sample could not be taken to the laboratory until the next working day, so it was kept in the fridge to preserve the sample.

Arguably the most important aspect of the treatment of this foal was the administration of plasma. A key feature of the history of this foal was that the mare had been running milk for 10 days prior to foaling and had therefore run out all her colostrum. Colostrum is the first milk, which is thick, yellow and sticky compared to milk itself. But why is colostrum so important?

When foals are born their immune system is mature enough to be able to respond to infectious challenges to the body. This is by the production of antibodies, which bind to infectious agents and trigger the destruction of them. Different infectious agents require different antibodies to fight them. In essence, the antibodies have to be custom-made to fight each particular infectious agent. However, this process can take several days before it is fully functional. Older animals rely on having been exposed to the infectious agent previously, and having a ‘memory’ of how to challenge it. They can trigger the process of releasing high numbers of the appropriate antibodies to fight that particular infectious agent very quickly as they have already previously ‘designed’ an antibody to fight it. Also, there are already a reasonable number of the antibodies in their bloodstream, patrolling the body in case there is a new challenge. However, newborn foals do not have any pre-formed antibodies, so their bodies are very naive and susceptible to infection. Humans overcome this problem because the placenta allows antibodies to cross from the mother to the baby, so the baby already has lots of antibodies in its blood by the time it is born. Unfortunately, this does not occur in animals, including foals. These antibodies are passed to the foal in the colostrum, the first milk. The antibodies in the colostrum are absorbed by the intestines and transferred to the blood stream, where they begin patrolling the body looking for any infectious agents that might have entered the body, and killing these infectious agents before they cause disease. This process is known as passive transfer of immunity. These maternally-derived (obtained from the mare) antibodies remain in the foal’s blood for several weeks. Their numbers start to decline by the time the foal is about 5 weeks of age, but by this time the foal’s own immune system has begun to mature and produce its own antibodies.

Mares produce 1-2 litres of colostrum. Therefore, a mare does not have to be running milk for very long prior to foaling before she loses all this colostrum before the foal can drink it. If you see your mare start to run milk before the foal is born, WITHOUT TOUCHING THE UDDER, you can collect it by holding a jug or bowl beneath her udder whilst it is running out, and then freeze it. Even if you collect the milk, it may not have any colostrum in it (especially in the case where you’ve found her in the morning and the udder could have been running all night), and even if there is colostrum, the mare may not have produced sufficient antibodies. Washed out milk bottles are good for freezing the milk/colostrum in. Always avoid actively milking the mare. If you are concerned that the mare has lost all her milk by the time the foal is born and you were able to collect the colostrum, this can be thawed and given to the foal once it is born. Thaw the colostrum by submersing the bottle in warm water. Do not use hot water or microwave the bottle as this will damage the important antibodies that you are trying to administer to the foal. You can try bottle feeding the foal. However, not all foals will bottle feed, especially if they have already suckled from the mare, because they will be full of milk from the mare and not hungry, and also because they will prefer sucking from the mare than from a bottle. Your veterinarian can overcome this problem by passing a tube up the foal’s nose and down into its stomach, to allow the colostrum to be deposited directly into the stomach. Only a limited amount of colostrum can be administered at one time, and it is best if the foal’s stomach is empty when this is performed, as this will allow more to be given. Therefore, the best time to do this is soon after the foal is born, before it has its first drink from the mare. The foal’s intestine is designed such that it can only absorb the antibodies in the colostrum until it is 12 hours old. After this age, there is no point administering colostrum as the foal cannot absorb the antibodies.

Not everyone is able to collect the colostrum if the mare runs milk prematurely. Some of the large studs have stores of colostrum. However, they may not be willing to part with this as they may want to preserve it for their own foals. The other option, if colostrum itself is not available, is to administer plasma to the foal.

The plasma product used in Australia is known as Equiplas®. It is collected from donor horses. These donors are hyperimmunised, which means they are stimulated to produce high numbers of antibodies in their blood, so their blood contains much higher numbers of antibodies than the blood of normal horses. Also, the donors are screened to ensure they do not have any diseases that could be passed to the recipients via the plasma. Plasma is kept frozen and must be thawed, like colostrum, prior to administration. It can be administered orally in foals less than 12 hours old, but it can only be given in frequent small amounts. The quickest method, and the only method that works in foals over 12 hours of age, is to administer the plasma intravenously, directly into the blood stream. The foal is restrained and a catheter is placed in the jugular vein. The plasma is then given like a drip into the vein. This whole process takes less than an hour. The dose is 1-2 litres per foal. If the foal requires 2 litres, the second litre must be administered at least one hour after the first, to avoid overloading the foal’s circulatory system with fluid.

Plasma is a very safe product to use. It forms a standard part of treatment of foals referred to veterinary hospitals when they are sick. Failure of passive transfer of immunity (not receiving adequate colostrum from the mare) has been implicated in the cause of a large number of infectious diseases in foals, including diarrhoea, joint ill (infection of one or more joints) and infection of the umbilicus. These problems can occur in isolation, or more than one can affect a foal at the same time.

If the foal stood up soon after birth (30 minutes to one hour) and suckled within 2-3 hours of birth, and the mare did not run milk prior to foaling nor had any major illness during pregnancy, then the foal is likely to have received adequate colostrum. If you want to be sure that your foal has received adequate amounts of antibodies from the mare, there are tests that can be performed, but not until the foal is at least 12 hours old. Some can be done as screening tests ‘stable-side’. If there is a suggestion that the foal may not have adequate levels of immunity, a blood test can be sent to the laboratory to obtain an exact evaluation. If this test indicates that the foal did not receive adequate amounts of antibodies from the mare, the foal can be administered plasma. Some owners choose not to run the tests, but to administer plasma regardless as it is such a safe product to give and has so many benefits. Any foal that begins to show evidence of being sick after birth, even if it is not showing specific signs, such as diarrhoea, can benefit from the administration of plasma before the disease process progresses. Therefore, the foals that receive plasma can be divided into three major categories:

  • Healthy foals
  • Healthy foals that have a blood test that suggests they did not receive adequate colostrum, or are known to have not received adequate colostrum
  • Sick foals

The administration of plasma is not a guarantee that your foal will remain healthy. There are many other factors in play. However, a lack of passive immunity from the mare is such a major risk factor that can be diminished significantly by the administration of plasma. Also, some foals that have the blood test and this indicates an adequate amount of antibodies in the blood can still get sick.

The major and perhaps the only disadvantage of plasma is the cost. It costs approximately $400 for a litre, on top of the other costs incurred when you call your vet out. However, many experienced breeders consider this a minimal cost in comparison to the cost of trying to treat a foal after it becomes sick, and prevention is better than cure.

In the case of the foal seen for diarrhoea, she remained bright and continued to suckle adequately. Over the course of the next 24 hours her manure began to firm up and she became stronger. She completed a course of antibiotics to be safe. However, she recovered so quickly, before the antibiotics really had a chance to begin to work, that the administration of plasma is likely to be reason for her swift recovery. At present she is still doing well.

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