Posted on December 27, 2009 by Scott Weese

Umbilical Care In Foals

As foaling season approaches, it's a good idea for people to review proper umbilical care. The umbilicus is an important route of infection in foals, and can be associated with problems including local umbilical abscesses, large abdominal abscesses extending to the liver, and overwhelming body-wide infection (sepsis). The reason the umbilicus is such a critical structure is that it contains three major blood vessels (two arteries and one large vein) and the urachus (which connects the umbilical cord to the foal's bladder) . When the umbilicus ruptures shortly after birth, these structures are exposed to the bacteria-laden environment of the outside world and can be a route of entry for local and deep infections. Care of the umbilicus during the initial high-risk period is a key part of raising a healthy foal.

Do all foal's need specific umbilical care? Not really. Most foals, especially those born normally in a clean environment to a healthy mare and who received adequate colostrum, don't need anything done. However, it's not always easy to differentiate these low-risk foals from others, and it is possible for the healthiest foal born in the cleanest environment with ingestion of an adequate volume of good quality colostrum to develop complications, so most people perform some form of post-birth umbilical care (and that's a good thing). The key is making sure that it's the right umbilical care.

The goals of umbilical care are pretty basic:

  • Prevent bacteria from entering the umbilicus.
  • Avoid damaging the umbilicus and other body tissues, and avoid delaying normal drying of the umbilicus.

What to use?

  • Research has indicated that a 0.5% chlorhexidine solution is the optimal umbilical dip. Other disinfectants can also kill local bacteria on the umbilicus but may not be as effective, may not work as well in the presence of debris (dirt, manure...), or may be irritating to body tissues.

Read the label:

  • Make sure you are actually using 0.5% chlorhexidine and that it's a solution (diluted in water), not a tincture (diluted in alcohol). If you don't have 0.5% chlorhexidine solution and are unsure about how to dilute it properly, ask your veterinarian.

More is not better!

  • Don't think that since 0.5% is good, 5% must be 10 times better. The stronger the concentration, the greater the chance of damage to local tissues, which can increase the risk of complications. Stick with 0.5%.

More is not better! Part 2

  • The umbilicus should be dipped in disinfectant, not marinaded in it! The goal is to cover the umbilicus and not other tissues (e.g. the abdominal wall). You don't need to soak the umbilicus or hold the disinfectant in place over it. Short term contact (dip) is adequate. Dip it and walk away. The umbilicus needs to dry up - repeated soaking isn't helpful.

More is not better! Part 3

  • The umbilicus should be disinfected shortly after birth, then every 6-8 hours for the first 24 hours of life. That's usually enough. If the umbilicus still appears wet at that time, it can be dipped again. Continued dipping "just is case" is not needed.

Don't tie off the umbilicus:

  • Tying off the umbilicus can actually increase the risk of complications such as infection and patent urachus (urination through the umbilicus).

Hands off!

  • Don't touch, poke or otherwise make contact with the umbilicus with your hands. It's not needed and it's a great way of transferring bacteria to the umbilicus.

If in doubt, call your veterinarian:

  • A proactive call to your veterinarian is much better and cheaper than an umbilical infection, umbilical abscess, septic foal or patent urachus. These are all expensive complications and  often difficult to treat successfully. Foals can change very quickly, and waiting to "see what happens" for a day or two can be the difference between a minor complication and a life-threatening problem.
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Posted on January 21, 2009 by Maureen Anderson

Foals Gone Wrong - One Bad Thing To Another

It's incredible how the vast majority of neonatal foals, perhaps especially those born in the cold mid-winter, are able to survive all the challenges they face the moment they hit the ground - clearing their lungs to take their first breath, learning to stand and suckle so they can get milk from the mare before their body reserves run out, suddenly being exposed to the elements and having to regulate their own body temperature, and a world of bacteria, viruses and other pathogens just waiting to take advantage of their unprepared immune system.

Mother nature has found ways to protect these unsuspecting newborns from many of these threats.  Horses are precocial animals, meaning their young are born relatively mature, so normal foals are able to stand and even walk within hours of birth.  This is in contrast to altricial species, like dogs, cats and people, whose young are born essentially helpless.  The umbilicus is meant to close off as it breaks off the placenta and soon dries out in foals that are able to stand, which helps prevent bacteria from invading through this portal.  The most important protection from infection for foals comes from the mare's colostrum, which provides antibodies that the foal absorbs into the bloodstream within hours.  The foal also receives special antibodies from the mare that stay in the intestine, coating the intestinal lining to help prevent invasion from bacteria the foal swallows while exploring its new world.  When everything goes according to plan, foals are happy and healthy and actually require very little human intervention to get there.

Unfortunately, when things go wrong with foals there is often a domino effect, with one bad thing leading to another.  If a foal can't stand, it can't get its colostrum, its umbilicus doesn't dry properly, and it soon becomes weak as its very limited energy reserves run out, making it even less likely to be able to stand.  If the umbilicus doesn't break properly or dry out as it should, bacteria may invade the foal's body, leading to infection of the bloodstream, liver or bladder, or a patent urachus which causes the foal to urinate through its umbilicus.  Without colostrum, even the normal bacteria from the foal's own mare and stall can be harmful.  One of the most serious consequences of any complication with a neonatal foal is called septicemia - the presence of bacteria and bacterial toxins in the bloodstream, which causes inflammation throughout the body, and can result in infection in almost any organ or body system.  The mortality rate for foals with septicemia varies widely between studies, anywhere from 33-75%.

There are a few things people can do to help prevent neonatal sepsis without interfering with mother nature, who already does far more than we ever could:

  • Keep things clean: Barns are not sterile environments, but making sure your mare foals in a nice clean stall on clean dry bedding can significantly decrease the amount and number of pathogens (particularly bacteria) that a foal first encounters when it hits the ground.
  • Keep mom clean: The very first creature a foal will encounter is its own mare, specifically her hind end.  As the mare approaches her foaling date, it's important to keep her hind end, tail and udder especially as clean as possible. (Most mares will foal when there's no one around, so you may not have a chance to clean her up right before she foals!).
  • Warm and dry: A cold, wet environment represents an additional challenge to a newborn's system, which can interfere with its ability to stand, suckle and fight off infection.  Try to ensure that the foal is born in a warm, dry place.
  • Colostrum:  Make sure the foal drinks enough colostrum.  If anything else goes awry, this is one of the most important things you can do to help protect the foal against additional complications.  If the foal doesn't nurse from the mare, bottle feeding and tube feeding colostrum are other options.
  • Umbilical care: The foal's umbilicus should close and dry out on its own, but in this case a little prophylactic treatment is warranted.  Dipping the umbilicus (without constantly soaking it) can help prevent bacterial invasion until it has dried out completely.

More information on colostrum and umbilical care are available in our archives and on the equIDblog Resources page.

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Posted on January 5, 2009 by Scott Weese

Starting Out Right: Foal Umbilical Care

The umbilical cord is the foal's lifeline in the uterus. Unfortunately, it can also be a great way for bacteria to enter the foal's body after birth. Infection of a neonatal foal's umbilicus can result in local infection at the site, a patent urachus (an open communication between the umbilicus and the bladder, resulting in urination through the umbilicus), abscessation of the umbilicus (which can extend all the way to the liver or back to the bladder) or sepsis (bloodstream infection). Fatal disease from an umbilical infection is not uncommon. Therefore, it's obvious that we need to try to reduce the risk of bacteria entering the umbilicus and causing infection.

Everyone that has foals should know about proper umbilical care. If umbilical care is neglected altogether or done improperly, the foal may be at serious (and unnecessary) risk of infection. Improper umbilical care, especially the use of irritating substances, can damage the delicate tissues, and may in fact do more harm than good.  Here are some important points about proper care of the umbilicus for foals:

  • Ideally, the umbilicus should be inspected and treated within 30 minutes of foaling (see picture right: normal umbilicus 20 minutes post-foaling).
  • The umbilicus should be dipped with a 0.5% chlorhexidine solution (NOT a tincture, which contains alcohol). This is preferred to iodine-based products. If iodine is used, milder forms (i.e. povidone iodine) should always be used, and they should be diluted properly prior to use. Stronger is not better - high concentrations of iodine can be very irritating and cause severe skin damage.
  • The entire umbilicus should be treated, but care should taken to prevent soaking areas around the umbilicus.
  • Umbilical treatment should be repeated every 6-8 hours for the first 24 hours of life, but do not over-treat the umbilicus - it is crucial that the tissues ultimately dry out.  The umbilicus should not be kept moist all the time, as this makes it easier for bacteria to invade the tissues.
  • Avoid touching the umbilicus directly with your hands. If this is necessary, hands should be washed thoroughly first or gloves should be worn.  Always wash your hands thoroughly after.
  • Any problems with the umbilicus (e.g. bleeding, urine coming out, large size, hot and painful, chronically moist) should be reported promptly to your veterinarian.
  • Suturing, tying or other forms of closing off the umbilicus should be avoided if at all possible.
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