Post Foaling Procedures - Routine (Low Risk Foals)

I. Care of Umbilicus

1. Allow the cord to sever on its own, unless foaling in a contaminated environment where the severed umbilicus would immediately become infected.
2. If foaling in a contaminated area or performing a cesarean section, ligate the cord while it is constricting, with sterile umbilical tape or clamps, 1-1/2 and 2-1/2 inches from the body wall. Dip area in chlorhexidine (0.5%) solution and sever cord between ligatures. Dip exposed cord in chlorhexidine solution.
3. Apply chlorhexidine (0.5%) (Novolsan 2% solution diluted 1 part with 3 parts sterile water) q 6 hr for 24 hr and watch for heat or swelling.
   Editor's Comment - This is better than 2% iodine or betadine; don't use 7% iodine [1].

II. Examine Placenta for Integrity, Weight and Signs of Abnormalities

Placentas weighing >10% of the foal's body weight may be abnormal.

III. Perform Physical Examination of Foal

See Physical Exam of the Equine Neonate

IV. Administer 1500 Units Tetanus Antitoxin if Dam not Given Toxoid Booster in Last 4-6 Weeks

V. If IgG is Low Determine Colostrum Quality and Supplement

See Colostrum - Assessment of and Sources for Foals

VI. Enema

1. Many foals are given a non-irritating enema to assist with complete passage of meconium.
2. Use fleet enemas®, soapy water (mild soaps only).

1. Use very soft tubes in the rectum. Be cautious so as to not penetrate or injure the mucosa.
2. Volume 4-6 ounces.

3. Repeated enemas may be irritating and can cause mucosal hemorrhage and edema and produce more straining.
4. Acetylcysteine (Mucomyst)® a mucolytic agent diluted in water has been effective in human infants in rapidly dissolving meconium (See Meconium Retention)

VII. Complete Blood Count

Optional. An in-utero problem or early infectious condition may be suggested from an abnormal CBC.

VIII. Arterial Blood Gas

Optional - Can be obtained from umbilical arteries at birth.

IX. Antibiotics

Since most neonatal infections are caused by gram-negative bacteria, standard doses of penicillin or penicillin-streptomycin are unlikely to provide significant benefit.
Editor's Comment - The routine use of post birth antibiotics is controversial. With good management, cleaning the mare and rapid ingestion of colostrum antibiotics may not be needed. Routine use of antibiotics lowers incidence of septicemia in some settings [3]. Since most infections are gram negative and often mixed infections, use broad spectrum antibiotic combinations such as Procaine Penicillin 20-30,000 Units/kg intramuscularly and gentamicin 6.6 mg/kg intramuscularly once daily for 48-72 hrs. (In a 50 kg foal 5 cc of 300,000 U/ml Procaine pen and 3.3 cc of 100 mg/ml gentocin.)

X. Vitamins

Selenium injections and oral vitamin E (800-1500 units) may be valuable in foals that are asphyxia cases.
Editor's Comment - These foals may have elevated serum CK enzymes or have maladjustment syndrome; use in foals born to mares from selenium deficient areas not receiving selenium supplementation.

XI. Digestive Tract Inoculums

Digestive tract inoculums are not recommended, due to current lack of evidence of benefits. Liver failure and death occurred in foals following administration of a digestive tract inoculum shortly after birth; the inoculum contained excessive iron [3].

XII. Exercise

1. If the foal is normal size and has normal limb conformation, it should receive paddock exercise beginning at day two. Editors Comment - Most foals have some valgus deformities and that is normal [4] (see Limb Deformities - Flexural Deformities (Sagittal Plane))
2. Recent studies in New Zealand have suggested foals should have lots of exercise in the first 6 weeks of life which produces increased amounts of joint cartilage [5].
3. Poorly ventilated, dusty stalls pose more risks to healthy foals than exposure to most outdoor environmental conditions [6].