I am a referral veterinarian who specializes in internal medicine. This means that at this time of year I see a lot of sick newborn foals. A sick neonatal foal that requires intensive care and hospitalization can often survive and be a sound, healthy adult. But, such care is pricey. Average costs for a week of hospitalization can be $2,000 or more. Some of the many reasons that a foal may need hospitalization include; birth in a dirty environment (such as outside during a storm by the manure pile), dystocia (malpositioning at birth and subsequent delayed delivery), "red bag" or premature placental separation, placentitis (infection of the placenta and fetus in the uterus), neonatal maladjustment syndrome ("dummy foals" or "barker foals"), and/or septicemia of the foal secondary to failure of passive transfer (foal did not get colostrum shortly after birth). Discussion of each of these syndromes can be articles in and of themselves but, in general, these problems lead to 2 things that often occur together. First, the foal lacks immunity and/or has been exposed to large amounts of bacteria from the environment and second the foal's brain has suffered from lack of oxygen. Together the onset of systemic bacterial infections and the effects of lack of oxygen in the brain lead to a weak foal that cannot function normally.

Colostrum and milk are essential for a foal to thrive. A healthy foal should stand and nurse within 1-3 hours after birth. Thereafter a healthy foal will nurse once or more each hour, have a bit of a romp around and then will nap in between nursing bouts. ANY behavior that is different from this is abnormal. Similarly, a mare should pass her placenta within 3 hours after foaling. ANYTHING more than that is abnormal. The first milk from a mare is the colostrum. Colostrum is rich in sugar and antibodies. Foals acquire the majority of their antibodies, which the body uses to fight off infection, passively through ingestion of colostrum. Unlike humans, antibodies do not cross into the neonate's blood stream by crossing the placenta. Nursing shortly after birth also protects a foal from disease. A foal's intestinal tract is "open" at birth, this means that it readily absorbs large molecules from the gut into the blood stream. This is the mechanism that allows foals to absorb the large protein molecules that are antibodies. Once a foal nurses and the gut is exposed to colostrum or milk it rapidly closes and will no longer absorb any large molecules. Foals that do not drink anything for many hours after birth but are exposed to manure, dirt, mud and other unclean environments may ingest bacteria into the mouth and therefore their gut. Once in the gut the bacteria may be absorbed into the blood stream. This predisposes the foal to systemic infections (septicemia) that can be life threatening. A mare will only produce colostrum for the first 6-12 hours after birth after that she will produce milk. Mare's having their first foal or that have leaked milk extensively prior to delivery will often have poor quality colostrum.

Educated owners that monitor their foal's birth and activity can identify a problem sooner. The earlier problems induced by lack of colostrum and lack of oxygen are identified and treated the less likely the foal will need long term intensive care. It is often heart breaking for horse owners and veterinarians to lose foals to septicemia secondary to lack of colostrum ingestion when the problem may have been completely preventable. Every veterinarian has their own preferred method of handling mares around the time of foaling. What I have outlined here is my version of the "Gold Standard". Please talk and consult with your veterinarian about what the best way they recommend to manage your growing horse family.

Know when you mare is going to foal. Average gestation for a mare is 332-340 days. Sit down with a calendar and know when your mare's due date is based on her breeding and ovulation dates
If you can't watch your mare 24 hours a day around the time she is due to foal consider sending her to a barn that foals out mares as a business. They should have experienced help and round-the-clock foaling watchers. This can be money well spent when you consider the cost of the death of your foal and/or mare due to a dystocia (difficult birth), a slow starting foal or a retained placenta.
Foals born before 332 days or after 340 days should be considered "high risk" there may be a medical reason for the foal to be born earlier or later than average.
Before Birth: If your mare is dripping milk and/or has vaginal discharge during the days prior to delivery, have a veterinarian examine her immediately. These can be signs of placentitis, a bacterial infection of the uterus and placenta. If caught early this may be treated and premature delivery of the foal and or a still birth may be averted. Foals born alive to such mares may appear normal immediately after birth but will then weaken quickly unless treated.
Time = 0: Have your mare and foal examined by a veterinarian immediately after the foal is born. At this time any congenital abnormalities of the foal may be identified. Your veterinarian will have a better feel for the vigor of your foal than you may have. The placenta should be kept for the veterinarian to examine (do not let the mare or your dogs eat it). Your veterinarian wants to be sure that the placenta is whole. If pieces of it are left in your mare she may develop a severe infection. Never pull the placenta out yourself. Some practitioners like to give the mare mineral oil at this time because post-delivery colic is not uncommon.
Time = 1-3 hours: During this time your foal should be alert and making early attempts to stand. By three hours the mare should have passed her placenta and the foal should have had its first nursings of colostrum.
Time = 3-10 hours: During this time your foal should be nursing once or more each hour and having a romp around the stall. Between nursings the foal will nap soundly but will wake up, get up and nurse readily. The mare should be resting comfortably and have a good appetite. If the foal is not passing manure and is straining, an enema can be given. The foal should urinate often and urine should not drip from the umbilicus.
Time = 10-12 hours: Have your veterinarian examine the foal again at 10-12 hours of age, no matter how vigorous your foal may seem. At this time your veterinarian should do a Foal IgG (antibody) test. Several types are on the market many of which can be run "stall side". This will tell your veterinarian whether your foal received enough colostrum or not. Many owners and veterinarians will skip the IgG test or delay running it until 24 hours of age in foals that appear vigorous. The problem with this practice is that if the foal failed to ingest adequate quantities of colostrum it will not be known until 24 hours of age or until the foal starts to weaken. Identification of a high risk foal as determined by a low IgG now will allow therapy to be initiated 12 hours or more earlier than it would otherwise which can make all the difference. Some veterinarians prefer to do a complete blood count and blood chemistry at this time as well.
Time = 12+ hours: Your foal should continue to nurse vigorously. Signs of a weakening foal include: failure to nurse hourly, extended periods of sleep, failure to respond to the environment, rolling up onto the back, grinding teeth. If you have any doubts as to the health of your foal seek veterinary care immediately.

Early intervention in sick neonatal foals can be life-saving and money-saving. Breeding and foaling out horses is not an inexpensive enterprise and putting some time, energy and funds into your peri-natal care can save you big in the long run.

About the Author:
Click here for more information about Jennifer M. MacLeay, DVM, PhD.