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46 WINTER 2014 K KEENELAND.COM compassionate care against the stalls' cinder block walls. The NICU is, in fact, a working barn that resembles ones you'd see at any of the Thoroughbred farms surrounding Hag- yard. Lead shanks and an empty feed tub hang on each of the metal-grate stall doors, along with a bag full of the brushes grooms use to keep horses' coats clean — a remind- er that these patients are also horses that need their regular care. But there are many signs of the NICU's true function. Visitors and staff alike must slide on ankle-high rubber boots and then step into a tub of liquid disinfectant (foot- bath mixtures throughout the facility are "virucidal, fungicidal, bactericidal," said Brown) before entering the unit, and there are additional rectangular foot dips outside each stall — the most visible part of the comprehensive bio-security protocols Slovis has implemented at Hagyard. "One of the things that's unique about our hospital is that, in this age of bio-security, we have the segmentation of populations of hors- es, which is probably very much more protective," Brown said. "We have surgery cases that stay in surgery facilities; we have internal medicine cases that stay in internal medicine facilities; we have in- fectious disease cases that stay quarantined in separate facilities. We implement an extreme bio-security program that protects patients while they're in the hospital." Foals here frequently beneft from proce- dures, equipment, and technology familiar to human medicine: ultrasound machines, defbrillators, ventilators, a hyperbaric chamber — all of these technologies and more are available for foals and their dams. And keeping mare and foal together when- ever possible is one of the hallmarks of Ha- gyard's neonatal facility, Brown said. "We know how intimate that relation- ship is for the normal development of foals in the wild but also in our domesticated horses," Brown explained. "In some of these very intensive cases, sometimes it's coun- terproductive for them to stay together. Sometimes there are challenges that make it diffcult to do the best thing for the pair if they stay together. We're very fortunate in this area to get to work with such great nurse- mare providers. They help us foster foals with wonderful mothers that take on these orphans and raise them as their own. These nurse mares provide them with the same social care and interaction that we know are very helpful in terms of these foals reaching the poten- tial of full development as racing athletes." Most of the foals in the unit are Thoroughbreds, and the unit's big- gest rush occurs between March and May, around the peak of foal- ing season at Kentucky's commercial Thoroughbred farms, which breed and sell racing prospects. But the unit's services are open to all breeds and types of horses. A stay in the NICU can range into the thousands of dollars, but the treatment options — and the dedicat- ed observation and intensive hands-on care foals receive from the unit's veterinary technicians and nursing staff — are often impos- sible to duplicate at a farm, where high-level bio-security is hard to maintain and workers must divide their time among more horses. Bringing their A game One blustery March morning, technician coordinator Hewlett de- tailed one case that illustrated the level of technology and nursing care that go into these foals' treatment. A large chestnut flly was delivered by Caesarean section before her dam died, and, concerned that she might not have received enough oxygen to her brain, vets placed the flly on oxygen via intranasal tube. "You also have to be worried about pneumonia, with the amount of fuid in the lungs, because they're not being born the natural way," Hewlett said. "We were feeding her through a stomach tube the frst day, but today she's doing really well. She's bright, and she has a great suckle refex, so we've started feeding her from a pan. It's fun to see The NICU's "Mayo Clinic model" combines advanced medical technology and dedicated nursing care. "They leave and have a good prognosis," Dr. Nathan Slovis, left, said of most NICU patients.

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