Retrospective cohort study on diseases and risk factors associated with death in hospitalized neonatal foals.
Authors: Castelain Donatienne L, Dufourni Alexander, Pas Mathilde L, Bokma Jade, de Bruijn Eva, Paulussen Ellen, Lefère Laurence, van Loon Gunther, Pardon Bart
Journal: Journal of veterinary internal medicine
Summary
# Neonatal Foal Mortality: Identifying Critical Risk Factors for Clinical Decision-Making Sepsis dominates neonatal foal disease presentations, accounting for 43.9% of cases in this retrospective cohort of 222 hospitalised foals aged seven days or younger, with an overall case fatality rate of 33.3%. Using Cox survival analysis and classification and regression tree modelling, researchers identified three independent predictors of mortality: L-lactatemia (≥4.2 mmol/L conferring a 4.4-fold increased hazard ratio), comatose mental state (2.9-fold increase), and elevated serum amyloid A (≥2054 μg/mL, 3.9-fold increase). Whilst the Cox model demonstrated high specificity (95.7%) for identifying foals at risk, its low sensitivity (7.5%) limits its clinical utility; conversely, the classification and regression tree approach showed better sensitivity (38.1%) at 86.1% specificity by incorporating hypercapnia as an additional risk marker. These findings suggest that blood lactate concentration and neurological status at admission represent pragmatic, readily measurable prognostic indicators—potentially supporting difficult conversations between veterinarians and owners regarding ongoing intensive care versus welfare considerations—whilst challenging the traditional diagnostic weight placed on blood glucose and immunoglobulin G levels in neonatal prognostication.
Read the full abstract on PubMed
Practical Takeaways
- •When evaluating sick neonatal foals at admission, prioritize assessment of mental status and request L-lactate testing—elevated lactate (≥373.8 mg/L) and coma significantly increase mortality risk and should inform discussions about prognosis and treatment intensity
- •Sepsis is responsible for nearly half of neonatal foal hospitalizations; use serum amyloid A (≥2054 μg/mL) as an additional risk stratification tool alongside clinical signs to guide owner conversations about economic feasibility and welfare considerations
- •Standard laboratory parameters like glucose and IgG levels have limited prognostic value for predicting survival—focus clinical decision-making on clinical presentation (mental status), L-lactate, and inflammatory markers instead
Key Findings
- •Sepsis was the most prevalent disease (43.9%) with a case fatality rate of 33.3% among 222 hospitalized foals ≤7 days old
- •Comatose mental state, L-lactatemia ≥373.8 mg/L, and serum amyloid A ≥2054 μg/mL were independent risk factors for death with hazard ratios of 2.9, 4.4, and 3.9 respectively
- •L-lactatemia and comatose mental state were identified as key prognostic indicators by CART analysis with 38.1% sensitivity and 86.1% specificity
- •Common laboratory variables such as blood glucose and IgG were not reliable predictors of survival in neonatal foals