Premature foals require multiple monitoring modalities and therapies from the first minutes through the first weeks of life. This paper discusses a case of a premature Paint colt born at 313 days gestation. The colt was vigorous and breathing spontaneously immediately after delivery. Considerations within the first twenty-four hours were monitoring and supporting respiratory, cardiovascular and renal function; preventing infection; maintaining normothermia; and providing nutritional support and nursing care. Complications arising during the colt's hospitalization included a severe lactic acidosis, generalized seizures, hyperbilirubinemia, anemia, bilateral corneal ulcers, a patent urachus and aspiration pneumonia. Premature foals often also have incomplete ossification of the carpal and tarsal bones that can lead to complications limiting athletic potential. The colt was discharged from the hospital at 36 days of age and follow-up revealed no significant abnormalities associated with his cuboidal bones, suggesting a good prognosis for athletic performance.