Race against time: Saving the life of a newborn foal after complicated ‘red bag delivery’

The newborn filly was not breathing.

“We could feel a faint heartbeat and proceeded with CPR, focused on rescue breathing as her heartbeat got stronger,” said Kristi Dorsey, owner of the filly, and her mother. “Miraculously, she took her first breath nearly 25 minutes after delivery.”

But that didn’t end the concerns for Kristi Dorsey and her husband, Clif Dorsey, of Dillsburg, Pennsylvania.  The filly had been through a “red bag delivery,” or premature separation of the placenta before and during the birthing process. Once this occurs, the foal is separated from its blood and oxygen supply. It is a serious emergency, and the placenta must be torn open and the foal delivered immediately to give the foal the best chance of survival. 

“Due to her lack of oxygen, we were concerned for numerous reasons,” Kristi Dorsey said. “She was clearly a dummy foal, with zero suckle reflex, but worse, she could not stand. After trying all that we could on-site with the assistance of our vet, we loaded up the mare and foal and brought them" to the Marion duPont Scott Equine Medical Center (EMC).

Lacey Assets, known as Lacey, an 18-year-old paint broodmare with a first-time bout of placentitis, and her newborn foal were admitted for emergency care at the equine medical center, a teaching hospital of the Virginia-Maryland College of Veterinary Medicine, in Leesburg, Virginia.

Placentitis is inflammation of the placenta usually caused by an infectious agent such as bacteria or fungi. This often occurs when the infectious agent is able to enter through the vulva or it can enter through the bloodstream in a mare that is very systemically ill. Mares with poor conformation or who have suffered an injury to the vulvar or cervix opening may be more prone to developing placentitis.

Lacey was being monitored around the clock by the Dorseys, and they were on site within minutes of Lacey going into labor. After identifying the red bag, the placenta was torn and the delivery was assisted to get the foal delivered as quickly as possible. The Dorseys immediately worked together – rescue breathing and stimulating the foal - and by the time their veterinarian, Madison Edwards DVM '21, associate veterinarian at Green Glen Equine Hospital, arrived the foal had started to breathe on her own.

Deciding to commit to giving the precious filly the best chance of survival, the mare and foal were transported on April 27 for emergency treatment in what Kristi Dorsey describes as “the wee hours of the morning.”  

Sarah Dukti, clinical assistant professor of emergency and critical care, and her team were waiting at the EMC for their arrival. At this point, Lacey’s foal was 6 hours old, she was unable to stand on her own and showed signs of weakness and clinical signs of hypothermia. She had a weak suckle reflex and uncoordinated limb movements. 

The filly was immediately started on oxygen therapy, and plasma and administered fluids with intravenous nutrition. Her treatment plan included systemic antibiotics, gastric protectants, and vitamin supplementation. She was placed in a warm bed to slowly bring up her body temperature. The center's foal watch volunteers sat with her, changing her recumbency frequently to prevent pressure sores. 

The following day Lacey and her foal’s care transferred to the EMC medicine team. Elizabeth MacDonald, clinical instructor of equine medicine, called Kristi Dorsey with an update.

“From the first phone call from Dr. MacDonald, we received the utmost empathy, which we truly appreciated,” Kristi Dorsey said. “However, what we appreciated even more was the straightforward information and the time spent to ensure we understood exactly what was happening, and collectively discussing the plan for the upcoming hours.”

The foal showed initial signs of positive progress. Her body temperature had returned to normal and her mentation had improved. She was able to start receiving milk through a feeding tube. She was able to stand with assistance but then did have a setback and started to look weaker again.  

“While the recovery started out strong, she had two significant setbacks during that time.,” Kristi Dorsey said. “Twice we gave a 24-hour time limit to see promising forward progress. While terrified we would have to make an incredibly hard decision, both times we were rewarded with great improvements, which gave us hope that she truly could make a full recovery. The doctors inquired about how far we were willing to go for this filly and they made every effort to stay within our limits.

“No, this little vacation for the filly was not inexpensive. It was quite costly, but it was worth every single penny.”

Over the next few days, the filly grew stronger and she was gradually weaned off her IV fluids and nutrition. By the morning of May 1, she was able to stand and walk on her own. She was introduced to the mare and was latching on to nurse for short periods of time. Repeat blood work confirmed her overall improvement.

Lacey loved her filly and was always concerned about her whereabouts, but she was unsure about letting her nurse without human supervision. The filly was not strong enough yet to work hard to nurse. Because of Lacey’s reluctance to allow her filly to nurse, a maternal bonding protocol was used. Lacey immediately accepted the foal and let her nurse on her own without supervision. Once the filly was reliable nursing regularly on her own, she was ready to head home. 

When Lacey and her filly - since named Chantilly – arrived home, Kristi Dorsey took over 200 pictures of them out in the paddock and told MacDonald: “I wish I could hug each and every person who aided in Chantilly’s recovery. From the doctors and nurses to the volunteers who sat with her while she wasn’t able to stand on her own. Our hearts are overflowing with gratitude for the love and care they were both shown. 

“Breeding isn’t for the faint of heart. I’ve heard this phrase so many times over the last few years. This year, I couldn’t agree more. From performing CPR on a lifeless foal to watching that same filly walk out of the hospital nine days later beside her momma, the roller coaster of emotion and stress was crippling. 

“But that precious filly, the one running around our pasture right now like she’s never been sick a day in her life …. she is our reward.”