Many newborn foals need specialized care to address medical challenges that commonly arise during the first weeks of life. During their presentation at the 2024 American Association of Equine Practitioners Convention, held Dec. 7-11, in Orlando, Florida, two board-certified internal medicine specialists—Laura Javsicas, VMD, Dipl. ACVIM, of Rhinebeck Equine, in New York, and Lisa Edwards, DVM, Dipl. ACVIM, ACVECC, of the University of Florida’s College of Veterinary Medicine, in Gainesville—shared their protocols for treating equine neonatal health issues in the field.

Diarrhea in Newborn Foals

Loose manure in foals can cause important health problems, with severity often varying by age. Neonates under 24 hours old with hemorrhagic diarrhea need immediate attention because this bloody manure can indicate clostridial (a type of bacteria) infection in the abdomen and an increased risk of sepsis (bacteria in the bloodstream). Diarrhea in foals over 2 weeks of age typically concerns practitioners less but still warrants veterinary care.

When managing foals with diarrhea, Javsicas and Edwards generally treat them with a di-tri-octahedral (DTO) smectite for toxin adsorption and intravenous (IV) fluids with dextrose for hydration and nutrition, and they conduct bloodwork to assess electrolyte imbalances, glucose and lactate levels, and renal function. Additionally, performing polymerase chain reaction (PCR) testing on the foal’s manure could help veterinarians identify the infectious agents.

Javsicas and Edwards said veterinarians prefer the antibiotic ceftiofur to treat diarrhea in foals and add metronidazole if they suspect a clostridial infection. The veterinarians added that ultrasound and nasogastric tube (NGT) placement are critical for identifying and relieving any gastric reflux in foals with diarrhea and coliclike signs.

Dehydration and Electrolyte Imbalances in Newborn Foals

Foal diarrhea poses a significant risk of dehydration and can lead to life-threatening electrolyte imbalances, especially hyponatremia (low sodium). For severe dehydration cases veterinarians can turn to a continuous rate infusion (CRI) of IV fluids. Balanced electrolyte solutions are ideal; veterinarians can also add dextrose and sodium bicarbonate (to counteract severe metabolic acidosis) if necessary, Javiscas said.

Both veterinarians recommended closely monitoring foals’ urine output during rehydration as a key indicator of kidney function. They also warned that despite practitioners’ best efforts to manage these cases on the farm, foals with severe electrolyte imbalances or signs of septicemia warrant a hospital referral.

Patent Urachus in Newborn Foals

A patent urachus occurs when the connection between the bladder and umbilical cord fails to close after birth. Veterinarians typically see this condition in foals that spend more time lying down than normal (i.e., “bed babies”), twins, or foals with abnormal or infected umbilical cords. They can treat most cases medically with antibiotics and local wound care, but regular ultrasound monitoring is important to assess the urachus and ensure there are no deeper infections, said Javiscas and Edwards.

Common patent urachus treatments include hypochlorous acid products and povidone-iodine (Betadine), which also have a skin-drying effect that can be beneficial in these cases, Javsicas said. Veterinarians generally only consider surgery if the condition doesn’t improve with medical treatment after 10 to 24 days.

Milk Replacement

Sick foals that cannot nurse need equine-specific milk replacers; Javsicas and Edwards noted that using milk formulated for other species can lead to diarrhea and electrolyte imbalances. If a neonate cannot nurse from its dam, veterinarians might use bottle or NGT feeding as alternatives. But if a foal can’t ingest milk from any source for any significant amount of time, veterinarians should provide IV dextrose supplementation and complete parenteral nutrition.

Take-Home Message

With strategic and resourceful field care, veterinarians can significantly improve outcomes for newborn foals affected by common health issues. Edwards and Javsicas emphasized the importance of thorough diagnostics, timely interventions, and informed treatments to protect neonatal health during this critical stage.