Metabolic and endocrine profiles in sick neonatal foals are related to survival.
Authors: Armengou L, Jose-Cunilleras E, Ríos J, Cesarini C, Viu J, Monreal L
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary Neonatal foal illness triggers significant metabolic and endocrine changes, yet few studies have systematically evaluated how these alterations relate to clinical outcome. This prospective observational study measured a comprehensive panel of metabolic markers—including triglycerides, nonesterified fatty acids, glucose, renal parameters, hepatic enzymes, insulin, cortisol, ACTH, and bile acids—in sick foals (both septic and nonseptic) compared to healthy controls, sampling on admission and during hospitalisation. Sick foals demonstrated markedly elevated urea, creatinine, and cortisol concentrations (2- to 8-fold higher than controls), whilst septic foals showed approximately 4-fold elevations in ACTH; notably, the ACTH/cortisol ratio was significantly lower in sick foals, suggesting dysregulation of the hypothalamic-pituitary-adrenal axis. The researchers identified a practical prognostic score based on three parameters—creatinine, glutamate dehydrogenase (GLDH), and cortisol—such that when two or more variables were abnormal on admission, foals faced a 32-fold increased mortality risk (95% CI, 7.7–130.3). Measuring plasma creatinine, GLDH, and cortisol at presentation provides clinicians with an objective, readily available tool for early risk stratification in sick neonates and may help guide intensity of intervention and prognostic counselling during the critical first hours of hospitalisation.
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Practical Takeaways
- •Measure plasma creatinine, GLDH, and cortisol on admission in sick neonatal foals to rapidly assess mortality risk and guide treatment decisions
- •Abnormality in 2 or more of these three markers should trigger aggressive intervention and closer monitoring, as they indicate substantially increased risk of death
- •These metabolic and endocrine markers provide objective, readily available tools to support prognosis assessment and owner communication in critically ill neonates
Key Findings
- •Urea, creatinine, and cortisol were 2–8-fold higher in septic and non-septic sick foals compared to healthy controls
- •ACTH concentration in septic foals was approximately 4-fold higher than in non-septic and control foals
- •When ≥2 of the following variables were altered (creatinine, GLDH, or cortisol), foals had 32 times greater risk of mortality (OR 31.7; 95% CI 7.7–130.3)
- •ACTH/cortisol ratio was significantly lower in sick foals compared to control foals