A 7-Minute Ultrasound Protocol That Could Transform Neonatal Foal Emergencies 🐎📈

Development and application of a focused ultrasound protocol in neonatal foals

Nicola Ellero, Alessandra Maggi, Valeria Busoni, Ilaria Imposimato, Carolina Castagnetti, Aliai Lanci, Jole Mariella, Francesca Freccero

Background

Point-of-care ultrasound (POCUS) protocols are increasingly implemented in equine medicine; however, standardized protocols tailored to neonatal foals are lacking. Due to anatomical and physiological differences between adult horses and foals, adult-focused protocols may not be directly applicable to neonates. This study aimed to develop and evaluate a standardized focused ultrasound (FUS) protocol for thoracic and abdominal assessment in neonatal foals, and to determine its feasibility, applicability, and diagnostic usefulness in both healthy and sick foals. The authors hypothesized that selected ultrasonographic windows would allow the creation of a practical, focused protocol capable of detecting common thoracic and abdominal abnormalities with minimal invasiveness.

Methods

Client-owned foals younger than 30 days admitted during the 2024 foaling season were prospectively enrolled. Seventeen healthy and 23 sick foals underwent a 12-window thoraco-abdominal Focused Ultrasound (FUS) protocol performed by a clinician with limited ultrasound experience after brief training. The protocol included four right-sided, three ventral, and five left-sided acoustic windows. Feasibility and organ visualization were assessed in healthy foals, while diagnostic usefulness in sick foals was evaluated retrospectively by comparing FUS findings with final diagnoses. Based on results, a shortened 7-window Foal Oriented Compressed Ultrasound (FOCUS) protocol was developed and tested in six additional foals by three clinicians with varying levels of experience to assess examination time and practicality.

Results

The full FUS protocol was completed in most foals, although some windows were not acquired, particularly in sick individuals due to clinical priorities or positioning constraints. In healthy foals, the protocol enabled consistent visualization of major intra-abdominal and intrathoracic organs, and organ measurements were generally within previously reported reference ranges.

In sick foals, FUS demonstrated high diagnostic usefulness, particularly for gastrointestinal disorders and peritoneal effusions. Abnormal findings included gastric dilation, reduced or absent intestinal motility, dilated and turgid small intestinal loops, “target-like” lesions consistent with intussusception, meconium retention, peritoneal effusion, bladder rupture, and pleuropulmonary abnormalities. Gastrointestinal and abdominal fluid abnormalities were most frequently detected in right ventro-lateral and ventral windows, especially the retro-sternal window.

The shortened FOCUS protocol eliminated left-sided windows, allowing examination from a single right recumbency. It was significantly faster, with a median acquisition time of 7 minutes (range 3–10 minutes), and maintained practical applicability in both healthy and sick foals.

Limitations

Limitations include single-operator acquisition of FUS images, limiting assessment of inter-operator variability; a relatively small cohort of sick foals evaluated with FUS; and limited validation of the FOCUS protocol in a small number of cases. Additionally, precise assessment of superficial structures such as umbilical remnants may have been affected by probe selection.

Conclusions

The FUS protocol is feasible and diagnostically useful for detecting common thoracic and abdominal abnormalities in neonatal foals, even when performed by veterinarians without extensive ultrasound experience. In emergency settings, the shorter FOCUS protocol may be preferable due to improved time efficiency and simplified execution, while maintaining clinical applicability.

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