Antibiotic therapy should provide broad-spectrum coverage. Generally, an aminoglycoside for gram-negative coverage plus a
beta lactam or a cephalosporin for gram-positive coverage is adequate. One can expect a mixed bacterial component due to the
non-sterile nature of the aspirated milk.
In cases where there is severe stridor and upper airway obstruction, an emergency tracheotomy might be necessary. This might
need to be done before you have made your diagnosis. This is most likely to be seen in foals with pharyngeal cysts, arytenoiditis,
bilateral paralysis of the arytenoids and severe pharyngeal collapse.
As discussed earlier, etiology of DDSP in the neonatal foal has been attributed to redundant soft-palate tissue, persistent
epiglottic frenulum, prematurity, perinatal asphyxia and NMD. Many times, no etiology can be found. Surgical approaches have
been recommended in the cases of redundant soft palate and persistent epiglottic frenulum, but with rest and supportive care,
many foals with simple DDSP will resolve in two to four days on their own. Subsequently, it is probably prudent to treat medically
first. If the pharyngeal muscular weakness is secondary to prematurity or perinatal asphyxia, then treatment of the primary
problems is important.
Specific treatment for NMD is the administration of a vitamin E/Se supplement (E-Se®) by intramuscular injection (1 ml/45
kg). This can be repeated in three and eight days. Foals should be confined to the stall and all physical exertion minimized.
Dill reports that foals that survive, regain strength and the ability to swallow gradually of two to six days.
In the case of pharyngeal cysts, surgical removal has been performed through a laryngotomy or pharyngotomy approach. Transendoscopic
laser surgery has also been successful and perhaps less traumatic than traditional surgical approaches. For immediate relief
of the airway obstruction involved in the dorsal pharyngeal cyst, one can use an endoscopic biopsy instrument to puncture
and drain the cyst.
Surgical repair can be attempted for the correction of cleft palates in the foal. It is difficult to obtain adequate visualization
without a mandibular symphysiotomy. Complications include dehiscence of the repair, chronic nasal discharge stunted growth
and osteomyelitis of the mandibular symphysis.
Foals with milk aspiration do surprising well. In a survey of 38 foals with upper airway problems/aspiration pneumonia, 82
percent recovered or improved with medical care and support. Those that were euthanized had the following diagnoses: bilateral
laryngeal paralysis, bilateral arytenoiditis, septic pneumonia and congenital heart defect. A study on the long-term outcome
of surviving foals has not been done. Anecdotal reports have been favorable but athletic performance has not been evaluated.
Mary Rose Paradis, DVM, MS, Dipl. ACVIM (LAIM) has been a professor in the Tufts Cummings School of Veterinary Medicine since
1983. She is director of the Marilyn Simpson Neonatal Intensive Care Program, associate professor Department of Clinical Sciences,
primary investigator for the Dorothy Havemeyer Foundation since 1990 and chair of the Board of Regents of the ACVIM in 2005-2006.
Her major clinical interests include equine neonatal intensive care, equine geriatrics and internal medicine. She is a frequent
contributor to veterinary publications and editor of new Equine Neonatal Medicine: A Case Based Approach, to be released this
Spring by Elsevier.