Premature Foals a Priority for Palmer

(Deirdre Biles profiles the University of Pennsylvania New Bolton Center in this article from the August 26, 2000 issue of The Blood-Horse.)

Saving the lives of critically ill and premature foals is a high-tech undertaking at the New Bolton Center.

"A lot of the equipment you see on the television show 'ER' we have here," said Dr. Jon Palmer, an associate professor of medicine and the director of the center's neonatal program. "We have respirators, heart monitoring equipment, blood pressure monitoring equipment, and equipment that monitors exhaled gasses. We even have a defibrillator. I only wish I could get blood gasses as fast as they do on 'ER.' "

Palmer and his staff treat approximately 120 newborns each year, including calves, kids, fawns, and zebra foals. "For some reason people like to consult with me on rhinoceros babies," Palmer said. "I don't know why, but I've talked to quite a few zoos. Actually, rhinoceroses are not so far away from horses on the evolutionary tree." However, the vast majority of Palmer's patients -- 80-85% -- are horses. The average stay costs from $3,000 to $6,000 for around-the-clock care and ranges up to $20,000 for the sickest animals.

The good news is the NBC's neonatal intensive care unit (ICU) sends 80-85% of its patients home, an increase from the 75-78% survival rate of 10 years ago. In addition, a recent study showed 59% of the Thoroughbreds discharged from the unit ran in at least one race. If they competed more than once, their performance over a two-year period was not significantly different from that of a control population.

"In their first year of racing, the Thoroughbreds (that are discharged from the ICU) don't do quite as well as their peers as far as earnings, but by year two, they catch up," Palmer said. "We feel the effort is worthwhile because we can produce a foal that can live up to its athletic potential."

For research purposes, the ICU's large caseload is a benefit, according to Palmer, "because we can change things and see whether or not we've been successful over a short period of time. Every year," he added, "we try something new."

In one recent change, foals in the ICU no longer are treated prophylactically with anti-ulcer medication. Many foals do not need such therapy, and to some, it actually may be harmful because the stomach acid can act as a barrier to infection, explained Dr. Pamela Wilkins, an assistant professor of medicine who works with Palmer.

"One of the things Jon encouraged us to look at was how much sodium we give these foals," Wilkins said. "We used to have a lot of problems with edema, and he felt like we essentially were overloading the foals with sodium that was in all the IV (intravenous) fluids they received. This year, we started doing sodium restriction with our IV fluids and my clinical impression was that we saw a lot less edema."

In addition to treating ill foals after they are born, Palmer and his staff oversee a high-risk pregnancy program for mares and female animals of other species that have the same problem year after year or have new problems that put their pregnancies in jeopardy. A mare typically is admitted to the ICU three weeks prior to her due date, and she is cared for by a team of specialists and monitored intensively. A team of specialists also attends her delivery.

"A mare's parturition is so explosive that you need to intervene quickly if you are going to save the foal," Palmer said. "We have a routine where each specialist gets a few minutes to make an assessment, and we try to move things along as fast as we can. One thing Dr. Wilkins and I have perfected is we don't wait until the foal is born to start resuscitation. We begin as soon as their nose is available to us. We will put a tube down into their lungs and start breathing for them. That allows the reproduction specialist more time to correct the problem or us more time to get the horse on the operating table for a cesarean section."

Not every member of the ICU staff during foaling season is a veterinary expert. Approximately 90 volunteers provide support, performing such tasks as sitting with sick babies, delivering blood samples to the lab, restocking supplies, and doing laundry. An executive assistant at a television station in the Philadelphia market, Chetty Ferry, has been a volunteer for two years.

"It's rewarding helping these little sick animals; it brings out your compassion," she said. "You clean up after them, help turn them if they can't stand up, and keep their IV lines from getting tangled. When they get better, it's a great feeling to think that you might have done something to make that happen."

Click here to read Special Feature: Pet Projects, a profile of New Bolton Center by Deirdre Biles.