Dummy Foal Syndrome – Sheldon

Sheldon was a 4 hour old Thoroughbred colt that was presented to the Camden Equine Centre Neonatal ICU for “red bag” delivery and inability to stand and nurse.

Sheldon recumbent at presentation

The colt was recumbent at presentation. Physical examination revealed a depressed mentation, a very poor suckling reflex and generalised weakness leading to inability to stand even assisted.

Our major concerns were complications from “red bag” delivery, namely asphyxiation leading to lack of oxygen delivery to the brain. This commonly leads to a syndrome called hypoxic ischemic encephalopathy (HIE) or “dummy foal” syndrome.

Arterial blood was obtained and analysed. The results suggested a lack of adequate oxygenation. Bloods were also submitted for hematology and biochemistry, which revealed a failure of passive

transfer (low IgG levels). Ultrasound of the chest, abdomen and umbilical structures were also performed. Ultrasound of chest and abdomen were normal throughout hospitalization.

Sheldon managed intensively round the clock

Resuscitative efforts were commenced and included IV fluid therapy, intranasal insufflation with oxygen, systemic antibiotics, judicious antiinflammatories, gastric protectants and neuroprotectants. Intravenous administration of a commercial plasma was also commenced to combat failure of passive transfer.

Sheldon remained recumbent and in a near comatosed condition for 3 days. He was managed intensively round the clock by equine medicine resident Dr Celine Lee, a dedicated team of veterinary interns and residents under the direction of equine medicine specialist Dr Liz

Tee. Management regiment included ICU monitoring round the clock, administration of scheduled medications, cleaning of the colt, supporting the colt in sternal recumbency and

Sheldon’s up and drinking from mummy!

dipping of his umbilical stump.

From day 4 of hospitalisation, Sheldon started to show gradual signs of improvement. His strength improved and he was slowly able to “right” himself into a sternal recumbency. He also gradually exhibited “teat seeking” behaviour, nuzzling at everything in sight. At day 6 of hospitalisation, he was strong enough to make several attempts to rise. He was able to stand for short periods of time assisted. Sheldon stood up unassited by day 7 and was seen nursing his mare that morning.

One small complication noted was the development of a patent urachus (urine dripping from umbilical stump). Sheldon was discharged home with oral antibiotics and a recheck at home 2 weeks later revealed a big, healthy and lively foal, with a resolved patent urachus!

Dummy Foal

Hypoxic ischemic encephalopathy (HIE) or more commonly known as “dummy foal syndrome” as a complex, multifactorial disease affecting newborn foals. Typically, foals are born relatively normal (although some are abnormal from birth) and start showing neurological signs within 6-12 hours of birth. There is usually a sentinal event during labor, but some “dummy foals” are born with very uneventful births. Common sentinal events include dystocia, “red bag” delivery or placentitis.

The first sign of a foal with HIE is the loss of affinity for dam and loss of suckling reflex, despite being normal for the first 6-12 hours of life. Some foals are unable to stand or suckle right from birth. There is a wide range of severity of HIE. Mild cases are usually seen as loss of suckling reflex and can recover with some medical intervention and time within a day or two. More severely affected foals will start to show generalised weakness and having difficulty getting up and down. Severely affected foals

Sheldon up and running

progress to become comatosed. Some severely affected foals can also develop kidney failure and severe diarrhoea.

The cause of this syndrome is mainly due to lack of oxygen to the foal’s brain and this asphyxia is thought to occur at some time during parturition.

This causes various degrees of brain damage and in some cases, damage to kidney and the gastrointestinal tract.

The current treatment regiment for a HIE foal includes supportive therapy in the form of IV fluids and administration of intranasal medical grade oxygen. Some HIE foals can develop sepsis hence broad spectrum antimicrobial coverage during this time is important.

Sheldon at home with Mum

There are some drugs that are thought to be neuroprotective in these cases such as magnesium sulfate that can be administered to these foals. In addition, these foals also require ongoing nutrition, and that can be either in the form of mare’s milk fed via a stomach tube, or total parenteral nutrition (complete nutrition in liquid) administered via an intravenous route if the patient is intolerant of tube feeding. These foals also need to be monitored with intensive nursing care round the clock, including cleaning of belly button, turning the foal every 1-2 hours to prevent bed sores and cleaning up defecation and urination to prevent scalding.

In uncomplicated HIE cases, foals will be comatosed for approximately 3-4 days. They will gradually regain their neurological function over another 1-2 days. This is when they show more alertness to surrounding, improvement muscle strength and some will struggle to rise. By the end of a week, these foals should be able to stand with minimal assistance and start to interact more with his mare. The last neurological function to return is usually the suckle reflex.