When he was born, “Abraham” had a myriad of serious medical issues, issues that began even before delivery. His dam was struggling with a bout of laminitis, and her pregnancy was deemed high-risk. She was admitted to the Graham French Neonatal Intensive Care Unit (NICU) at New Bolton Center where she delivered a full-term male foal on April 11, 2012. “He was,” remembers Jon Palmer VMD, DACVIM, “probably one of the most critical foals we had last season.” Dr. Palmer is Director of Perinatal/Neonatal Programs, Chief of Neonatal Intensive Care Service and an associate professor at Penn Vet.
“Abraham had us waiting eagerly for his arrival,” said internal medicine resident Michelle Abraham BSc, BVM, “and having slept nearby the mare for many nights, we were as prepared as we could have been for his arrival. It was apparent immediately during his birth that this foal would need a lot of assistance and would have many challenges ahead.”
The veterinarians were correct. The 108-pound foal needed intensive care right from birth. He had failure of multiple organs with a very slow heart rate, very low blood sugar, neurologic disease, kidney disease and intestinal disease. On top of that, he had a very significant fungal infection of his skin, kidneys, and eyes, as well as corneal ulcers that could have resulted in blindness. “This was a generalized, systemic infection,” said Dr. Palmer.
Drs. Palmer and Abraham, working with a team of skilled technicians, swiftly triaged the foal’s needs, addressing each problem with speed and efficiency.
The intravenous fluids the foal received for his poorly-functioning kidneys required constant assessment to assure the correct balance. Intranasal oxygen was administered. He also received antibiotics and antifungal drugs, as well as drugs to support his blood pressure and circulation, and drugs to improve kidney function. Eye medications were dispensed, applied, and he was fed intravenously.
“Without this initial care,” said Dr. Palmer, “the foal would have died.” Clinicians from other specialties worked in concert with the NICU team, including those from ophthalmology, orthopedics, anesthesiology, and imaging, as well as the farrier.
In addition to the veterinary specialists, the NICU’s strong support staff of highly skilled technicians, many of whom are trained on site, was vital to Abraham’s recovery. “Someone attended the foal 24 hours a day,” said Dr. Palmer. “Clinicians and nurses would be in and out of his stall, and a volunteer foal sitter or patient care technician, a kind of specially trained nursing assistant, was there all the time.” Until he was able to stand, Abraham rested on a sheeted mattress, with nursing staff turning him and encouraging him to stand every two hours. He was kept dry and clean, and positioned in such a way that additional problems—such as bedsores—could be avoided.
“We have to be committed to these foals every second,” explained Dr. Abraham. “One of the keys to his treatment and care was to try to be one step ahead of Abraham at all times to provide the support he needed. That is not always an easy task.”
The NICU is designed to accommodate the special needs of critically ill neonatal patients, with matted walls, hardware for hanging pumps, hot air blankets, oxygen outlets in each stall, ventilators, specially designed stalls that allow mare and foal to remain close, without impeding treatment, and video cameras for constant monitoring.
“The first week was very tough,” recalled Dr. Palmer, “but once we were able to get him off the IV feeding, we reached a turning point. He rallied and started to do very well. It was quite dramatic.”
Abraham soon developed his own determined personality, one that entertained his care team greatly as they supported, encouraged and watched him make the gradual transition into being a foal that learned to stand on his own and explore his stall. Once he was up and around, he grew more and more inquisitive.
Forty-two days after birth, the foal, nicknamed Abraham by his owners in appreciation of the care and attention he received from Dr. Abraham, was moved to a local lay-up facility near New Bolton Center’s campus. For close to a year, either Dr. Abraham or Dr. Palmer has visited him on a weekly basis. Although he improved greatly, some medical concerns remained that required close monitoring. New Bolton Center ophthalmologists made farm calls to tend to his corneal ulcers, which had originally affected more than 90 percent of his left cornea and 30 percent of his right. Field Service has seen him for regular health care.
Because of his issues as a newborn, Abraham was never able to suckle properly and was raised as an orphan. His eyes slowly improved, and his other medical issues resolved. Renal issues often linger for quite a while, according to Dr. Palmer, but a recent blood test indicated that his kidney functions should now be considered normal.
He is a small thoroughbred, probably weighing in at about 800 pounds, pretty close to average. Because he was orphan-raised, he is well socialized and gets along very well with people. But, says Dr. Palmer, “He is a typical yearling in most respects. He is not so difficult to handle, but definitely has his own opinions about what he will let you do. He is trying to assert some dominance.”
Added Dr. Abraham, “It has been an incredible journey with Abraham. One of the best parts of my week is going to visit him. We are excited for each upcoming chapter in his life, and we will definitely be there as his biggest supporters.”