Diagnosis and Treatment of Dysphagia in a Day Old Foal
Balcom, Andrea K.
A 24-hour-old Morgan colt presented to Cornell’s Large Animal Medicine service as a referral for aspiration pneumonia. During the foal’s initial wellness examination, the referring veterinarian heard increased bronchovesicular sounds and crackles and wheezes in the cranial ventral lung lobes bilaterally. An ultrasound and radiographs showed cranioventral consolidation of the lungs bilaterally. Due to the serious nature of pneumonia in neonates as well as the value of the foal, the foal was referred to Cornell for further evaluation and treatment. On presentation, the colt was bright, alert and responsive. Vital parameters were within normal limits. An ultrasound of the thorax revealed mild to moderate pleuritis with cranioventral consolidation, consistent with pneumonia. A brief oral exam ruled out the possibility of a cleft palate. A nasogastric tube was placed and the foal muzzled so he could not nurse. The following day the nasogastric tube was removed, foal was allowed to nurse, and an ensuing endoscopic examination revealed milk in the trachea, indicating the foal was aspirating when he suckled. No upper airway structural abnormalities were detected on endoscopic examination. The foal and his dam were hospitalized for two weeks. During that time the pneumonia was treated with a course of antibiotics while potential causes of the foal’s dysphagia were explored and different treatment options tried. Repeat endoscopic exams every 2-3 days confirmed that the foal was still unable to nurse without aspirating. He was, however, able to pan feed without aspirating. He was discharged with the recommendation to continue pan feeding. This case report will explore the etiology of dysphagia in the neonatal foal, as well as the treatment options available and supportive care necessary to maintain these patients.
Aspiration pneumonia; Dysphagia; White Muscle Disease; Hypothyroidism; Neonatal Maladjustment Syndrome; Pharyngeal Dysfunction; Equine; Case studies