Factors associated with outcome in 94 hospitalised foals diagnosed with neonatal encephalopathy.
Authors: Lyle-Dugas J, Giguère S, Mallicote M F, Mackay R J, Sanchez L C
Journal: Equine veterinary journal
Summary
# Editorial Summary: Neonatal Encephalopathy — Identifying Prognostic Factors in Hospitalised Foals Neonatal encephalopathy remains the most prevalent neurological condition in newborn foals, yet little is known about which clinical and laboratory parameters predict outcomes in affected individuals. Lyle-Dugas and colleagues performed a retrospective analysis of 94 hospitalised foals (aged ≤14 days) diagnosed with neonatal encephalopathy between 1996 and 2007, using multivariable logistic regression to identify factors associated with nonsurvival. Although overall survival was encouraging at 79.8%, five variables significantly predicted poor prognosis: elevated serum total calcium, depressed alkaline phosphatase activity, recumbency, concurrent disease, and requirement for vasopressor or inotropic support — the latter being the only therapeutic intervention independently associated with mortality, indicating that persistent hypotension underpins nonsurvival in this population. These findings offer equine practitioners a practical framework for early risk stratification in neonatal foals, particularly highlighting that foals requiring vasopressor support represent a distinctly worse-prognosis subset, whilst electrolyte and enzyme abnormalities at presentation warrant careful consideration when formulating prognostic estimates and treatment plans.
Read the full abstract on PubMed
Practical Takeaways
- •Foals presenting with neonatal encephalopathy have reasonably good survival prospects (~80%), but those requiring vasopressors/inotropes for blood pressure support have significantly worse outcomes—focus on early stabilization and identification of concurrent diseases
- •Monitor serum calcium and alkaline phosphatase levels at admission; elevated calcium and low alkaline phosphatase are poor prognostic signs that should prompt discussion of prognosis with owners
- •Recumbency and multiple concurrent diseases substantially reduce survival chances; implement aggressive supportive care early but recognize when persistent recumbency and hypotension indicate guarded-to-grave prognosis
Key Findings
- •79.8% (75/94) of foals with neonatal encephalopathy survived to discharge, with 19 foals dying or being euthanized
- •Nonsurvival was significantly associated with elevated serum total calcium, low alkaline phosphatase activity, recumbency, multiple concurrent diseases, and vasopressor/inotrope use
- •Vasopressor/inotrope requirement was the only therapeutic intervention associated with nonsurvival, indicating persistent hypotension as a poor prognostic indicator
- •Multivariable logistic regression model correctly classified 92.0% of cases