“Doc –Can Navel Infection of Newborn Foals be Prevented?”
© A.J. Neumann, D.V.M.
published in The Draft Horse Journal, Spring 2009
So called “navel infection” or “joint ill” is a very costly disease complex for the horse or mule breeder. Foals of either sex, from any breed, can suffer from this condition. Many infected foals, who receive proper treatment, can be saved and go on to live a normal life. Others may become permanently disabled and some will die from the disease complex. The loss of these foals is very sad and costly because most cases can be prevented–prompt treatment of foals that develop the condition will usually bring about their recovery.
In my practice I have had a number of clients who have experienced a “bout” with navel infection in their foals. When I was foaling 10 to 15 mares, for a number of years, I learned quite a bit on how to treat and especially prevent this disease complex from occurring.
What is this condition known as navel ill or joint ill? These are terms applied to the infected foal who exhibits one or more joint infections; the bacterial source of which is through the neonate’s navel. The umbilicus is commonly thought to be the primary source of bacteria, but recent research has led many scientists to believe that the gastrointestinal and respiratory tracts are almost equally responsible sources of bacterial infection of the joints. Infected joints, or septic arthritis of foals, are often seen with the failure of the transfer of immune bodies in the mare’s colostrum to the foal as well as pneumonia and enteritis.
I believe, from personal experience, that some foals are infected in the uterus of the mare and are born with the disease in progress. I have seen some of these cases of joint ill when the neonate was only an hour old. Clients have told me that the foal was born lame, with joint swelling and a rise in temperature occurred an hour or two after birth.
While the infected navel cord stump can be the source of bacteria, causing navel ill in the foal, the so called wet navel is a 100% source of the problem. A foal with a “wet navel” is passing urine through it when the animal urinates. It may be a stream or the urine may constantly dribble from the stump of the cord. This condition is officially known as a Patent Urachus. If the Patent Urachus is left untreated, the foal will certainly become infected and be a classic case of navel ill or septic arthritis.
The diagnosis of joint ill is quite simple. The very first symptom that one may see is the fact that the newborn foal, two or three days old or older, may be lame. Many times I have been called by clients who have a lame foal and they invariably think the mare has stepped on it. This is far from the truth. Even though the body temperature may be normal, almost all of these cases are in their very first stage of navel ill.
Generally what is seen is one or more swollen, hot, painful joints with lameness of the affected limb present. There is usually a rise in body temperature accompanied by some loss of appetite and depression.
Analysis of a blood sample will often show increased blood fibrinogen concentrations.
An arthrocentesis of a swollen joint is the diagnostic test of choice to confirm the presence of septic arthritis. I have never had to perform this joint puncture test to diagnose the problem. I believe most cases can be readily diagnosed without resorting to this procedure.
The diagnosis of the joint infection is relatively easy but the treatment of the disease is another story. The use of broad spectrum antibiotics intravenously is the key to the successful treatment of this orthopedic infection. I have found that gentamicin given intravenously is much more effective than when given by another route. Since many of my clients cannot afford frequent veterinary calls to administer antibiotics in the vein, I have taught them to give intravenous shots to their stock. Other antibiotics are given orally and into the muscle of the rump area.
When an antibiotic such as penicillin is given intramuscularly it should never be administered into the muscles of the neck as they will become sore and the foal will be unable to twist its neck to nurse the mare.
The drugs I often use and have been successful with in treating navel ill are gentamicin, amikacin, tetracyline and penicillin. One should continue the administration of the antibiotics for at least one week after all symptoms have disappeared.
In extreme cases the joint may have to be flushed and antibiotics infused into it. In my practice I only had to do this one time on one foal. Some veterinarians routinely perform this procedure when treating navel ill patients.
One can understand that the treatment of a foal with septic arthritis can be a long and costly procedure. How about prevention? Can navel ill be prevented?
The answer is that while not all cases can be prevented, most of them can. Following is a program which, when carried out, seems to work.
Start with the dam. About one month before its foaling date vaccinate her for tetanus, flu and rhino. If she has not had these vaccinations within six months, give her a second round of these vaccines in two weeks. In addition, if you have not been feeding a Vitamin A and D supplement, the mare should be given at least 5 million units of Vitamin A and 700,000 units of Vitamin D by intramuscular injection into the muscle on top of the rump.
A clean area should be provided where the mare can foal. The very best place, I believe, to foal a mare is on good clean pasture ground. Of course that depends on the season of the year and its availability.
As soon as possible after foaling I would always give the mare an intramuscular injection of 20cc of aqueous penicillin and another dose of flu and rhino vaccine.
It is very important to treat the raw end of the umbilicus immediately after the foal is born. It is recommended to dip the stump of the navel with dilute chlorohexidine, providine iodine or dilute iodine solutions. I prefer to use 7% tincture of iodine solution–commonly known as strong iodine solution. Dipping once a day for two or three days is sufficient. Do not put this solution on the belly wall around the navel cord as it may cause scalding of the area.
It is very important that the foal be up and nursing as soon as possible. It must receive the dam’s colostrum in the first six to eight hours of its life. If the foal does not nurse in this timeframe, the mare will have to be milked and the colostrum given orally to the foal or administered to it with a nasal-gastric tube.
It’s very important to check the immune status of the foal. One wants to know if the foal has received adequate transfer of immunity, through the colostrum, from the mare. Most horsemen can perform this test themselves when the foal is 24 hours old. The most conservative test systems may be the ELISA systems. The SNAP test by Idex is a relatively good performer and is easy to use, giving a reading within an hour. This test kit or similar ones can be purchased from your veterinarian or an animal health store.
During the first eight hours after birth, a minimum of two liters of equine colostrum should be ingested by the foal. Bovine colostrum may be substituted safely but it may not contain antibodies to fight off disease caused by some equine bacteria.
If this is the case, the foal should receive equine plasma by an intravenous injection. I always used plasma from one of my own mares who had been blood-typed and was known to be free of serum alloantibodies and allioantigens. There are many commercial sources of equine plasma and it can be readily obtained. Again, the only drawback for its use is that the product may not contain specific antibodies for the equine pathogens on your premises. More than one injection of equine plasma may be needed to bring the amount of antibodies in the foal’s serum up to acceptable levels.
If a foal is diagnosed with a Patent Urachus, commonly called a wet or leaky navel, it will almost always develop navel ill if the condition is left untreated. I always place the foals on a high dosage of broad spectrum antibiotics until the problem is alleviated. Penicillin and trimethoprim-sulfa drugs are the ones I have used, plus Pyridium. While the foal is on the antibiotics I try to stop the flow of urine which is occurring in the navel cord stump.
Do not tie a suture or string around the cord! If you do, the navel cord will just rot off below the suture and the flow of urine will continue, often worse than it was before.
To halt the urine flow I usually attempt to cauterize the tip of the cord. A number of drugs can be applied to it, such as strong tincture of iodine, nitric acid, silver nitrate, butter of antimony and my old favorite, pickling lime. Just apply once or twice daily on the tip of the cord and usually after a few days the problem is solved.
If cauterization does not halt the urine leakage, one will have to perform surgery on the navel cord and close the tract. The surgery is simple, takes less than a half hour and can be performed on the farm. It has always worked for me, but I only resort to the surgical procedure if drugs and cautery fail.
Occasionally the navel cord will abscess. This condition can be treated medically and surgically. The foal must receive daily doses of broad-spectrum antibiotics and the abscess should be opened, drained and treated as an open wound. If caught early in its development, an abscess on the navel cord is very easy to treat.
Once in a great while a group of mares will begin to foal and the foals are born with navel ill. To treat these foals I have put them on intravenous antibiotics, intramuscular antibiotics and equine serum as soon as they are born. In addition I have cultured the dead and live neonates to determine the causative agent or bacteria. I then have an autogenous vaccine manufactured and administered to the mares for a period of two more foalings. This program appears to work in these herds.
So–back to the question, can navel infection be prevented? The answer is “yes!" Navel infection can be prevented in newborn foals in most instances. Start with the health of the mare, then do your part and monitor the health of the foal as I have described. The program will work for you, it does for me!