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Neonatal Intensive Care Service

New Bolton Center's Neonatal Intensive Care Unit

 The Neonatal Intensive Care Unit is designed to accommodate the special needs of the critically ill neonate as well as pregnant animals at increased risk for complications and provide their babies with lifesaving critical care beginning even before birth.

The NICU is staffed by neonatologists and residents with dedicated, specially trained veterinary technicians on site around the clock.

Delivering intensive care as soon as a problem is recognized is important when caring for neonates (newborns during their first month of life) to achieve a successful outcome. Critically ill neonates, especially foals, are often admitted to the NICU in the middle of the night, receiving intensive care within hours of birth.

The neonatologist and neonatology resident are important members of the New Bolton Center team that assembles within minutes when needed to attend a difficult birth, which allows them to begin lifesaving care for the often critically ill neonate during delivery. The team also includes members of the Sections of Reproduction (obstetricians), Emergency and Critical Care (surgeons) and Anesthesiology, as well as many other members of the hospital support staff.

The NICU offers a High-Risk Pregnancy Program for our equine patients. Download the High-Risk Pregnancy Program brochure (pdf).

Similar programs are designed for the special needs of cows, does, ewe, sows and hembras (alpacas/llamas).

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Do you have a foal that needs special care, but may not be critically ill?

The Graham French Neonatal Intensive Care Unit at Penn Vet’s New Bolton Center accommodates the needs of critically ill neonates. Specially designed stalls allow mares to have contact with their critically ill foals without disrupting the neonate’s medical care.

Special equipment:

  • In-stall oxygen and other medical gases
  • Mechanical ventilation for respiratory failure
  • Electrocardiography (ECG)
  • Capnography and pulse oximetry
  • Blood pressure monitors
  • Intravenous infusion pumps
  • Telemetry for fetal heart rate monitoring
  • Facilities to hoist and sling mares with special problems or needs during foaling
  • Specially designed facilities that allow for efficient administration of fluids
  • Forced hot-air warming 
  • Multiple imaging modalities, including ultrasound, radiography, MRI, and CT scan
  • Specially designed crash cart, respiratory equipment, and a defibrillator for cardiopulmonary resuscitation (CPR) in the event of cardiac or pulmonary arrest

 

 

Penn Vet’s New Bolton Center High-Risk Pregnancy Program

The High-Risk Pregnancy Program is designed for any mare at increased risk for complications and to detect fetal distress so that steps can be taken to support the foal before, during, and immediately after birth to increase the chances of a successful outcome. Specially designed stalls allow mares to have contact with their critically ill foals without disrupting the neonate’s medical care.

Candidates for the program include:

  1.  Mares with a history of past reproductive problems, including: dystocia, placentitis, premature placental separation, premature delivery, prolonged gestation length, premature or growth-restricted foals, foals with neonatal isoerythrolysis (jaundice foal), septic foals, or the delivery of “maladjusted foals.”
  2. Mares experiencing problems during their current pregnancy that can threaten the well-being of the foal, including pneumonia, neurologic disease, severe musculoskeletal disease, gastrointestinal disease, colic, body wall ruptures/hernias (“pre-pubic tendon rupture”), and abnormal abdominal enlargement. Other indications of fetal distress -- including premature udder development, vaginal discharge, or prolonged gestation length -- also qualify mares as having a high-risk pregnancy.

Mares enrolled in the High-Risk Pregnancy Program receive the following services:

  • Up to 21 days board before foaling and/or post-foaling
  • Complete physical examination of the mare and the foal
  • Reproductive examination of the mare: rectal palpation; transrectal ultrasonography to evaluate fetal position, fetal fluids, and placental health; vaginal exam (if needed); episioplasty (Caslicks) opened (if necessary); post-partum reproductive exam
  • Six transabdominal sonograms to evaluate fetal position, fetal heart rate and activity, fetal fluids, and placental health
  • Maternal blood work: complete blood count, fibrinogen, creatinine
  • Daily evaluation of fetal heart rate using fetal ECG
  • Daily evaluation of vulva, udder development, and pelvic ligament relaxation
  • 24-hour monitoring for delivery
  • Foaling with clinicians from Perinatology/Neonatology and Reproduction in attendance
  • Evaluation of fetal membranes
  • Routine blood work on foal: complete blood cell count, creatinine, fibrinogen, IgG level, umbilical blood gas, and umbilical blood chemistry

Additional services may be added to the base program (and incur additional fees), depending on individual mare’s needs. Examples of these additions include: antibiotic therapy, progesterone therapy, or other medications for the mare; induction of delivery, if indicated; cost of intravenous catheters, intravenous lines, oxytocin, and infusion solutions, if required; Cesarean section costs or other surgery; reproduction services; postpartum therapy for mare, if indicated, such as uterine lavage, uterine infusion, and uterine swab culture; special intensive care or critical nursing care of the mare or foal. Any additional fees and procedures will be discussed with the owner before proceeding. 

Mares will be turned out daily, unless the mare’s problems preclude exercise. Mares will be stabled in the ICU where they will be kept with other mares/foals and pregnant mares. Every effort will be made to minimize contact between pregnant mares and the rest of the general hospital population.

A senior clinician in Perinatology/Neonatology, in consultation with clinicians from the Section of Reproduction, will design a foaling program to meet each mare’s special needs.

 

Please call for pricing and to enroll your mare:

  • Dr. Jonathan Palmer, 610-925-6412, jepalmer@vet.upenn.edu
    Chief of the Neonatal Intensive Care Unit, Director of Perinatal/Neonatal Programs, Associate Professor of Medicine
  • Dr. Patricia Sertich, 610-925-6229, psertich@vet.upenn.edu
    Senior Reproduction Specialist and Associate Professor at New Bolton Center’s Hofmann Center for Reproduction and Behavior 

 For nearly 30 years, Penn Vet’s New Bolton Center has invited volunteers to assist clinicians and staff in caring for mares and foals during the busy foaling season. These “foal sitters” are vital to the functioning of the Neonatal Intensive Care Unit, making it possible to provide the highest quality of care to patients by ensuring there is enough help to deliver the labor-intensive treatment around the clock.

New Bolton Center currently enlists 90 “foal sitter” volunteers, including 50 who have participated in the past. In addition second-year Penn Vet students are required to foal sit for five shifts of six hours each as part of their curriculum.

Some foal sitters have participated for years, and include local horse owners and enthusiasts, volunteers from many local universities including West Chester University, Villanova University and the University of Delaware, retired individuals, high school students, and even a group of registered nurses from the Children’s Hospital of Philadelphia.

“They are very important for us,” said Dr. Jonathan Palmer, VMD, Chief of New Bolton Center’s NICU, and Director of Perinatal/Neonatal Programs. “To deliver the level of intensive care that we do, we need more help. Foal sitters are vital to our operation.”

Two foal sitters are assigned to each of the three shifts: 7 am to 3 pm, 3 pm to 11 pm, and 11 pm to 7 am. Foal sitting volunteer shifts start in February and go through June.

“Most mares foal between 11 at night and 6 in the morning,” Dr. Palmer said. “It is much more active at night. If you want to see the birth of foal, that’s when you want to be around.”

Possible duties for foal sitters include:

  • Holding foals that are lying down in various positions, depending on the foal’s needs
  • Assisting staff as they stand and turn foals as required
  • Changing bedding as needed, to keep patients clean and dry
  • Catching urine when required
  • Milking mares and storing the milk
  • Monitoring proper placement and attachment of patient fluid and oxygen lines, urinary catheters, and nasogastric tubes
  • Monitoring infusion pumps and other equipment for alarms and notifying a nurse, patient attendant, or clinician of any alarms
  • Restraining foals for a variety of therapeutic and diagnostic procedures, including blood drawing, catheter placement, and tube-feeding
  • Restocking treatment areas and treatment carts
  • Cleaning equipment and hospital areas
  • Assisting with set-up for incoming patients

Foal sitting registration takes place in December, with an orientation to follow in January. Foal sitters must be at least 16 years old. For more information about the program, send an email to foalsitters@nicuvet.com.

 

 

Clinical Faculty
Jon Palmer, VMD, Penn Vet, medicineJonathan Palmer, VMD, DACVIMChief of the Neonatal Intensive Care Unit, Director of Neonatal/Perinatal Program

With more than 35 years of experience as a veterinarian, Dr. Palmer has a worldwide reputation as a pioneer and innovator in the fields of neonatology and perinatology. He has developed techniques to monitor late-term, high-risk pregnancies and to begin treating the fetus before birth, as well as to deliver intensive care to the critically ill neonate. He has offered new insights to diverse areas of neonatal care, including fluid management, nutritional management, and techniques for successful cardiopulmonary resuscitation. Dr. Palmer is a prodigious researcher and writer, having published more than 200 journal papers, abstracts and book chapters. A 1977 Penn Vet graduate, he has trained more than 100 interns and residents, and dozens of visiting clinicians from practices around the globe.