Alessandro Pirrone

Venous blood lactate evaluation in equine neonatal intensive care.

The use of blood lactate concentration as an indicator of prognosis and disease severity has become a common practice in equine medicine, especially with the validation of handheld analyzers. However, few authors described lactate concentration in critically ill foals, and there are no published studies about the use of handheld analyzers in neonatal foals. In this study, for the first time in the equine neonate, we validated the Lactate Scout analyzer, both in healthy and in critically ill foals. The study also describes the normal range for blood lactate in 26 healthy neonatal foals during the first 72 h of life. Moreover, the utility of venous lactate measurement in 88 critically ill foals was determined, describing lactate values in the most common neonatal pathologies, evaluating serial blood lactate measurements, and investigating its prognostic value. The comparison with the enzymatic-colorimetric reference method showed that the Lactate Scout analyzer is reliable. The mean difference (bias +/-2SD) between the two methods was close to zero for all comparisons, and the SD of difference was +/-0.76 with a 95% confidence interval from -1.58 to 1.40 mmol/L. In healthy foals, blood lactate concentrations at birth and at 12h of life were statistically higher (P<0.01) than lactate concentrations measured at subsequent times. In critically ill foals, the highest lactate concentration at admission was found in hemorrhagic shock, septic shock, and complicated perinatal asphyxia syndrome (PAS). Our results showed that hyperlactatemia, although it does not provide diagnostic information, indicates the severity of illness and the need for an early and aggressive intervention. This could be very useful both during hospitalization and in the field to support veterinarians in making a decision about referral. Furthermore lactatemia proved to be a reliable prognostic parameter: In nonsurviving foals, hyperlactatemia persisted during the entire hospitalization, whereas in survivors there were no significant differences after 24h from admission. Because prognostic parameters have certain limitations, hyperlactatemia should not be used alone to decide whether to discontinue treatments in critically ill foals. A careful and complete clinical examination is always essential.

Hematologic and biochemical profiles in Standardbred mares during peripartum

The purposes of this study were to determine physiological changes occurring in hematologic and biochemical parameters in mares between the last month of gestation and the first week after parturition. If a significant change was observed with respect to the reference interval of an adult horse, a further aim of the study was to establish different reference intervals. Blood samples were collected from 62 healthy pregnant Standardbred mares. Seventeen nonpregnant and nonlactating mares were used as a control group. In pregnant mares, blood sampling was conducted every three days from 1 month before the expected foaling date (335 days after the last mating), at parturition, and 7 days after foaling. The barren mares in the control group were sampled once. Results from samples collected 20 and 10 days before parturition, at parturition, and 7 days after were considered in the statistical analysis. A parametric method for all the parameters studied was used to establish reference intervals. Results were compared by repeated measures ANOVA. When significant differences were observed in relation to sampling time, a post hoc analysis was performed (Tukey test). The one-way ANOVA test followed by Dunnetts test was performed to evaluate the presence of a significant difference between each sampling time and the control group. Any significant difference in the blood count parameters at different sampling times was observed by repeated measure ANOVA. Hemoglobin (P < 0.01) and hematocrit (P < 0.01) 7 days after parturition and white blood cell count (P < 0.01) at parturition were significantly different from the control group. Erythrocyte indices and platelet count were within the normal reference intervals as established in the control group. In the biochemical panel, gamma-glutamyltransferase, creatinine, glucose, biliar acids, total protein, albumin-to-globulin ratio, and calcium were significantly different at different sampling times. Moreover, serum concentration of creatine kinase, aspartate aminotransferase, creatinine, blood urea nitrogen, glucose, lactate, total protein, albumin, albumin-to-globulin ratio, calcium, magnesium, sodium, chloride, potassium, and total, direct, and indirect bilirubin was different from that of the control group. Remarkable changes were not observed in alkaline phosphatase, triglyceride, and fibrinogen concentrations. Temporal changes in the hematologic and biochemical parameters observed in the present study in the peripartum and the differences with reference intervals made up for nonpregnant and nonlactating mares could be used to better evaluate the conditions of periparturient mares.

Amniotic fluid and blood lactate concentrations in mares and foals in the early postpartum period

Amniotic fluid (AF) lactate concentration and time-dependent changes in blood lactate concentration in mares after parturition have never been evaluated. In this study, the venous blood lactate concentration of mares and foals during the first 72 h of the postpartum period was assessed, and the concentration of lactate in the AF collected during delivery and the utility of its measurement for evaluating the foals health were investigated. This prospective observational study was carried out on mares attended at delivery. They were divided into mares delivering healthy (Group 1) and sick (Group 2) foals. The following samples were collected: AF and umbilical blood at delivery, mares and foals jugular blood every 12 hours from parturition until 72 h postpartum (T0-T72). Sixty-two mares were enrolled in Group 1 and 19 in Group 2. In Group 2, the survival rate was 68.4%. The median blood lactate of the foals at T0 was 3.60 mmol/L in Group 1 and 5.05 mmol/L in Group 2. The monitoring of the blood lactate concentration showed a significant time-dependent decrease from T24 in the foals (P < 0.01) and from T12 in the mares (P < 0.01). Lactate concentration over time was significantly different between healthy and sick foals (P < 0.01) but not between mares with normal and dystocic delivery (P = 0.08). A significant difference (P = 0.04) was detected as regards AF lactate concentration between Group 1 (median 14.99 mmol/L) and Group 2 (median 12.61 mmol/L). For the first time, AF lactate concentration was evaluated during parturition, and significantly higher levels were found in mares delivering healthy foals. This was an unexpected and very interesting result which warrants further investigation involving a larger number of mares. Additional studies are needed before either mares blood or AF lactate concentration can be used in a clinical setting.

Effects of mesenchymal stem cells isolated from amniotic fluid and platelet-rich plasma gel on severe decubitus ulcers in a septic neonatal foal.

This paper documents the treatment of severe decubitus ulcers with amniotic fluid mesenchymal stem cells and platelets rich plasma (PRP) gel in a septic neonatal foal. The colt needed 25 days of hospitalization: during this period ulcers were treated for 15 days with mesenchymal stem cells (MSCs) plus PRP, PRP gel alone, or aloe gel. Healing was faster using MSCs+PRP, and at 7 months an ulcer treated with aloe gel was still not completely healed.

Expression of interleukin-1β, interleukin-8, and interferon-γ in blood samples obtained from healthy and sick neonatal foals

OBJECTIVE To evaluate and compare the gene expression of interleukin(IL)-1β, IL-8, and interferon-γ during the first 72 hours after birth in healthy foals and during the first 72 hours after hospitalization in sick neonatal foals and investigate correlations of clinicopathologic variables with cytokine expressions in healthy and sick neonatal foals. ANIMALS 33 foals < 7 days old (10 healthy foals, 7 foals with sepsis, 6 foals with peripartum asphyxia syndrome, and 12 foals with other diseases [2 with failure of passive transfer of immunity only were not further evaluated]). PROCEDURES A blood sample (15 mL) was collected from each foal immediately after birth or hospital admission (0 hours) and at 24 and 72 hours later. Clinicopathologic variables were evaluated, and cytokine gene expression in WBCs was measured with an absolute quantitative real-time reverse transcriptase PCR assay. RESULTS At all time points, gene expression of interferon-γ was low in all groups. No time-dependent changes in cytokine expressions were detected in healthy or sick foals. Foals with sepsis had significantly higher IL-1β gene expression than did healthy foals, foals with peripartum asphyxia syndrome, or foals with other diseases. At 0 hours, IL-1β expression was correlated with plasma fibrinogen concentration in healthy foals and with the neutrophil-to-lymphocyte ratio in foals with sepsis; IL-8 expression was correlated with monocyte count in foals with sepsis and with arterial pH, plasma fibrinogen concentration, and plasma lactate concentration in foals with peripartum asphyxia syndrome. CONCLUSIONS AND CLINICAL RELEVANCE Data have suggested that evaluation of IL-1β expression in sick neonatal foals could help identify those with sepsis.

Facial cellulitis due to Actinobacillus equuli infection in a neonatal foal

Actinobacillus equuli , a Gram-negative pleomorphic rod, is the causative agent of several diseases in horses. The most serious is an acute, usually fatal septicaemia of newborn foals known by the colloquial name ‘sleepy foal disease’, which causes lesions at several sites, including the kidneys

Histomorphometric parameters and fractal complexity of the equine placenta from healthy and sick foals

Computer-based digital image analysis of tissue samples shows promise both to reduce the subjectivity of traditional manual tissue assessments and potentially to shorten the time required to analyze each sample. The present study used digital image analysis to investigate the histomorphometric parameters and fractal complexity of the equine placenta from healthy and sick foals. We hypothesized that the placentas of sick foals could have a different growth pattern and complexity that could be objectively estimated by their fractal dimension (FD). Fourteen placentas from 30 mares were selected in the 2013 breeding season and divided into two groups: seven mares with normal pregnancy, eutocic delivery, and healthy foals (group 1) and seven mares with normal or high-risk pregnancy, eutocic delivery and sick foals (group 2). Four mares in group 2 were classified as having a high-risk pregnancy on the basis of anamnesis and/or ultrasound findings. Clinical diagnosis of group 2 foals included perinatal asphyxia syndrome (n = 4), prematurity/dysmaturity (n = 2), and both diagnoses (n = 1). Seven out of fourteen placentas showed diffuse gross abnormalities. Grossly abnormal placentas were observed in one out of seven (14.28%) animals in group 1 and in six out of seven (85.72%) animals in group 2. Digital image analysis proved to be reliable and efficient in segmentation, calculation, outline extraction of villi as also resulted in sampled test images. The placentas of group 1 foals displayed a uniform and homogeneous villi development, as revealed by geometric parameters and FD. These results can be interpreted as a harmonic growth pattern of microcotyledons throughout the placenta in healthy foals. By contrast, the placentas of group 2 foals showed a nonuniform growth pattern and complexity with more villi and more developed villi in pregnant horn (PH) and nonpregnant horn (NPH) compared with body (B) and higher FD in NPH than in the other areas. This finding can be interpreted as a compensatory growth with increased complexity. Our results show that morphometric analysis, particularly FD measurement, can be proposed as an ancillary histological tool for equine placenta evaluation. Chorionic villi tend to have greater branching and complexity in sick than in healthy foals, particularly in the NPH. This could represent an attempt to increase the exchange area between fetal and maternal compartments of the equine placenta, and merits further investigation.