Newborn Foal CPR: What to Do If a Foal Is Not Breathing

By Dr Duncan Houston

A newborn foal should begin moving and breathing within seconds of delivery.

When that does not happen, there is no time to search for equipment, find the veterinarian’s number or work out who knows how to use the resuscitation bag. The foal may still have a heartbeat, but without effective breathing, oxygen levels fall rapidly and the heart rate soon follows.

The most important principle in newborn foal resuscitation is simple:

Breathing usually stops before the heart does. Establishing an airway and ventilating the foal are therefore the first priorities.

Quick Answer

If a newborn foal is not breathing or is only gasping, remove the membrane from its nose, position the head and neck to open the airway, rub the foal firmly with towels and call your veterinarian immediately.

If regular breathing does not begin within seconds, start assisted ventilation. Chest compressions are added only when there is no heartbeat, the heart rate is below approximately 40 beats per minute, or it remains below 60 and is not increasing despite about 30 seconds of effective ventilation. Nearly 90% of newborn foals requiring resuscitation respond to ventilation alone. (Merck Veterinary Manual)

The Most Important Rule: Ventilation Comes First

Adult CPR often makes people think immediately about chest compressions.

Newborn foals are different.

Most compromised foals are delivered with a heartbeat but fail to establish effective breathing. Hypoxia then causes the heart rate to slow, eventually progressing to cardiac arrest if the foal is not ventilated.

That means compressing the chest without opening the airway and delivering breaths may circulate blood that contains very little oxygen.

For a foal with a heartbeat but no breathing, assisted ventilation is the life-saving treatment.

Chest compressions are necessary only if the heart has stopped or remains dangerously slow despite effective ventilation. (Merck Veterinary Manual)

What Should a Normal Newborn Foal Do?

A normal foal may initially look wet, awkward and mildly disoriented, but it should make clear progress within minutes.

Time after birth	Expected progress
Within seconds	Movement and spontaneous breathing begin
Within approximately 30 seconds	Regular breathing is established
After the first minute	Heart rate is above 60 beats per minute and rising
By approximately 10 minutes	Strong suckle reflex
By approximately 20 minutes	Attempts to rise
By 1 hour	Standing independently
By 2 hours	Nursing effectively

An initial respiratory rate of approximately 60 to 80 breaths per minute can be normal immediately after birth. It generally settles toward approximately 30 to 40 breaths per minute over the following hours. A healthy foal’s heart rate should be above 60 beats per minute after the first minute and is commonly closer to 80 to 100. (Merck Veterinary Manual)

The exact second matters less than the direction of travel.

A normal foal should become progressively brighter, stronger and more coordinated. A foal that remains limp, continues gasping or becomes less responsive is not making a normal transition.

Which Foals Need Immediate Resuscitation?

Start emergency intervention if the foal has:

• No spontaneous breathing

• Only occasional gasping

• Open-mouth gasping that does not become regular breathing

• A respiratory rate below approximately 10 breaths per minute

• No movement or righting response

• No response to firm towel stimulation

• A heart rate below 40 beats per minute

• A heart rate below 60 that is not increasing

• No detectable heartbeat or pulse

• Blue, grey or severely pale gums

• Severe weakness following a difficult birth

• Meconium obstructing the nose or airway

• Ongoing respiratory distress after delivery

A few initial gasps may occur, but they should develop into regular breathing within approximately 30 seconds. Persistent gasping is not adequate breathing and may also indicate severe upper airway obstruction. (PMC)

Do not wait for the foal to become completely pulseless before starting ventilation. Intervention before cardiac arrest carries a much better chance of success.

When Is This an Emergency?

A foal that is not breathing normally at birth is always an emergency.

Call your veterinarian immediately if the foal:

• Does not breathe within seconds

• Continues gasping beyond approximately 30 seconds

• Has a heart rate below 60 and falling

• Has no detectable heartbeat

• Is limp or completely unresponsive

• Has blue or grey gums

• Was delivered following dystocia

• Was born through a red bag

• Is heavily stained with meconium

• Has an obvious facial or airway abnormality

• Develops irregular breathing after initially appearing normal

• Starts breathing but remains profoundly weak

• Cannot maintain body temperature

• Coughs or has milk coming from the nostrils

One person should call the veterinarian while another begins basic resuscitation. Do not stop life-saving ventilation simply because the veterinarian has not arrived.

The First 60 Seconds: What to Do

Step 1: Start a Timer and Call for Help

Record the time of birth and call your veterinarian immediately.

Assign roles where possible:

• One person manages the mare

• One person assesses and ventilates the foal

• One person calls the veterinarian and retrieves equipment

• Another records times, heart rates and interventions

Emergency teams work better when everyone has a job. Four people simultaneously shouting “What do we do?” is technically teamwork, but not the useful kind.

Step 2: Remove the Fetal Membranes

Immediately remove any membrane covering the foal’s nose and mouth.

A healthy foal delivered inside an intact white amniotic membrane can suffocate if the sac is not cleared from the face promptly.

If a thick red membrane appears before the normal translucent white sac, this is a red bag delivery caused by premature placental separation. The red membrane must be opened immediately and delivery expedited because the foal’s oxygen supply has already been compromised. (Cornell Vet College)

Step 3: Position the Foal

Place the foal on its chest in sternal recumbency where possible.

Extend the head and neck into a straight, neutral position so air can pass through the nasal passages, pharynx and trachea.

If the foal is later moved onto its side for chest compressions, use a firm, dry surface and support its back to prevent sliding.

Step 4: Clear Obstructing Material

Use your fingers or a bulb syringe to remove visible mucus, fluid or meconium from the nostrils and mouth.

Suction should be brief and gentle. Prolonged or aggressive suction can worsen hypoxia and trigger vagal bradycardia. Stop suction once the foal begins breathing. (Merck Veterinary Manual)

Do not keep suctioning simply because some fluid remains. Newborn lungs normally contain fluid, and the aim is to remove material obstructing airflow, not to vacuum the entire foal.

Step 5: Stimulate Breathing

Rub and dry the foal firmly with clean towels, particularly over the chest, back and neck.

Tactile stimulation may be enough to initiate breathing in a mildly depressed foal.

Do not:

• Slap the foal’s face

• Strike its chest

• Shake it

• Pour cold water over it

• Suspend it by the hindlimbs

Hanging a foal upside down delays ventilation, restricts movement of the diaphragm and is specifically contraindicated in neonatal foal resuscitation guidance. (IVIS)

Step 6: Assess the Heartbeat

Use a stethoscope over the left side of the chest, just behind the elbow.

A femoral pulse may also be felt high on the inside of the hindlimb, but listening directly to the heart is usually more reliable.

Spend no more than approximately 10 seconds deciding whether a heartbeat is present. (PMC)

Then decide:

• Heartbeat above 60 and rising, but no breathing: ventilate

• Heartbeat 40 to 60 and rising: continue ventilation and reassess

• Heartbeat below 40: ventilate and begin chest compressions

• Heartbeat below 60 and not increasing after effective ventilation: begin chest compressions

• No heartbeat or no effective pulse: begin full CPR immediately

How Do You Provide Rescue Breaths?

The preferred method is ventilation through a properly placed cuffed endotracheal tube using a self-inflating resuscitation bag.

However, intubation requires training. Untrained repeated attempts can waste critical time, traumatise the airway or place the tube in the oesophagus.

A suitably fitted bag-and-mask device or mouth-to-nose breathing may be used temporarily when trained personnel and intubation equipment are unavailable. (Merck Veterinary Manual)

Ventilation With a Bag and Mask

A mask should fit securely over the muzzle and both nostrils.

To ventilate:

1. Extend the head and neck.

2. Hold the mask firmly enough to create a seal.

3. Deliver a breath over approximately one second.

4. Watch for visible but gentle chest expansion.

5. Allow the chest to fall fully before the next breath.

6. Provide approximately 10 breaths per minute.

Deliver only enough volume and pressure to make the chest rise.

Excessive ventilation can damage the lungs, fill the stomach with air and reduce blood return to the heart. Faster is not better. During an emergency, rescuers commonly ventilate much more rapidly than intended, so counting aloud can help maintain the correct pace. (IVIS)

If the abdomen is expanding while the chest is not, air may be entering the stomach rather than the lungs. Reposition the head, improve the mask seal and have a trained person check the airway.

Mouth-to-Nose Breathing

Mouth-to-nose ventilation is a temporary alternative when no bag, mask or endotracheal tube is immediately available.

To provide mouth-to-nose breaths:

1. Extend the foal’s head and neck.

2. Keep the mouth closed.

3. Seal your mouth around one nostril.

4. Close the opposite nostril with your hand.

5. Blow only until the chest visibly rises.

6. Allow complete exhalation.

7. Repeat at approximately 10 breaths per minute.

A protective barrier should be used where available.

Mouth-to-nose ventilation is less controlled than bag ventilation but is better than providing no breaths while waiting for equipment. Horses are obligate nasal breathers, which is why the nostril can be used as an emergency route. (PMC)

Nasotracheal Intubation

Nasotracheal intubation provides the most reliable airway and reduces the risk of air entering the stomach.

It should be performed by:

• A veterinarian

• Experienced veterinary staff

• Breeding-farm personnel who have received practical veterinary training

A crash kit may contain appropriately sized cuffed nasotracheal tubes, a syringe for the cuff, a self-inflating bag and oxygen equipment. However, buying the equipment is not the same as knowing how to use it.

The first intubation attempt should not occur during the first foal emergency anyone has ever witnessed. Practical training and rehearsal beforehand matter. (IVIS)

When Should Chest Compressions Begin?

Reassess the heartbeat after approximately 30 seconds of effective ventilation.

Begin chest compressions if:

• No heartbeat is detected

• The heart rate is below 40 beats per minute

• The heart rate is below 60 and is not increasing

• A heartbeat is detected electrically or by auscultation but there is no effective pulse or perfusion

These thresholds recognise that most neonatal bradycardia is caused by hypoxia. Ventilation is therefore attempted first unless the foal is already pulseless. (IVIS)

Do not begin compressions merely because the foal is not breathing if the heart rate is strong and rising. Concentrate on effective ventilation.

How to Perform Chest Compressions on a Foal

Position the Foal

Place the foal on its right side on a firm, dry surface.

Position the topline against a wall, rolled towels or another stable support so the body does not slide away from the rescuer.

Quickly feel along the ribs for obvious fractures if this can be done without delaying compressions. Approximately 3% to 5% of newborn foals may already have rib fractures from delivery. If fractures are suspected on one side, place that side down. (Merck Veterinary Manual)

Position Your Hands

Kneel behind the foal’s back.

Place one hand over the other:

• Directly over the heart, just behind the elbow, or

• Over the highest and widest point of the chest

Keep your elbows straight and your shoulders directly above your hands.

Compression Rate and Depth

Compress the chest:

• At 80 to 120 compressions per minute

• To approximately 40% of the chest’s width

• With full release between compressions

Allowing the chest to recoil is essential because this permits the heart to refill between compressions. Leaning continuously on the chest reduces the effectiveness of CPR. (Merck Veterinary Manual)

A rhythm close to 100 compressions per minute is a practical target.

How Do Breaths and Compressions Work Together?

With Two or More Rescuers

One person performs continuous chest compressions while another provides approximately 8 to 10 breaths per minute.

The rescuers do not need to pause compressions for every breath when the airway is secured and effective ventilation is being delivered.

With One Rescuer

Use:

30 chest compressions followed by 2 breaths

Continue this cycle until help arrives or the foal regains an effective heartbeat. (Merck Veterinary Manual)

Reassessment

Pause briefly every two to three minutes to assess:

• Heartbeat

• Heart rate

• Pulse

• Gum colour

• Spontaneous breathing

• Movement or response

Keep the pause under 10 seconds.

Rescuers performing compressions should change every two to three minutes where possible because fatigue quickly reduces compression quality. (Merck Veterinary Manual)

When Can Chest Compressions Stop?

Stop compressions when the foal has:

• A regular heartbeat above 60 beats per minute

• A detectable, effective pulse

• Improving gum colour and circulation

Continue assisted ventilation if the foal has regained a heartbeat but is still not breathing adequately.

Ventilation can be gradually withdrawn once the foal is breathing spontaneously with a regular pattern and maintaining a heart rate above 60 beats per minute. (IVIS)

Do not stop all support the moment one breath or one heartbeat appears. The foal must demonstrate that it can sustain both.

How Long Should CPR Continue?

If high-quality ventilation and chest compressions have continued for approximately 10 to 15 minutes without:

• A detectable heartbeat

• A pulse

• Spontaneous breathing

• Movement

• Improvement in circulation

the likelihood of successful resuscitation becomes extremely poor.

The decision to stop should ideally be made with the veterinarian, taking into account the duration of arrest, birth history, suspected congenital abnormalities and whether any response has occurred. (Merck Veterinary Manual)

If the foal is showing meaningful improvement, resuscitation should continue.

Why Might a Newborn Foal Need Resuscitation?

Difficult or Prolonged Foaling

Dystocia can reduce oxygen delivery through:

• Umbilical cord compression

• Premature placental separation

• Prolonged uterine contractions

• Delayed delivery after the placenta begins separating

The equine placenta separates readily during delivery, which is why stage-two labour must progress quickly. A foal that remains trapped after oxygen delivery has been interrupted may deteriorate rapidly. (Cornell Vet College)

Red Bag Delivery

In a red bag delivery, the placenta separates prematurely and appears as a thick red membrane at the vulva.

The foal is losing its oxygen connection to the mare and must be delivered immediately.

Even if the foal initially breathes, it remains at risk of:

• Hypoxic brain injury

• Weakness

• Neonatal encephalopathy

• Organ dysfunction

• Failure to nurse

• Sepsis secondary to poor colostrum intake

Meconium Aspiration

A stressed fetus may pass meconium before birth and gasp while still inside the uterus, pulling contaminated fluid into the airway.

Meconium can obstruct the airway and cause inflammation, impaired gas exchange and persistent pulmonary hypertension. Heavy meconium staining is therefore more than a cosmetic mess. (PMC)

Prematurity or Dysmaturity

Premature and dysmature foals may have:

• Weak respiratory muscles

• Inadequate lung maturity

• Reduced surfactant

• Poor thermoregulation

• Weak suckle reflexes

• Poor cardiovascular adaptation

These foals may initially breathe but remain unable to maintain adequate oxygenation.

Caesarean Delivery or Maternal Anaesthesia

Foals delivered under general anaesthesia may be depressed by medications administered to the mare.

They may require ventilation, warming, cardiovascular support and appropriate reversal medication administered by the veterinary team.

Placental Disease

Placentitis, placental insufficiency, twinning and other placental abnormalities can impair fetal oxygen and nutrient delivery before labour begins.

The foal may already be compromised before the first visible sign of foaling.

Congenital Airway Problems

Persistent gasping or an inability to move air despite apparently correct ventilation raises concern for:

• Bilateral choanal atresia

• Severe nasal deformity

• Upper airway obstruction

• Cleft palate

• Laryngeal or pharyngeal abnormalities

• Congenital lung disease

A foal with complete bilateral nasal obstruction cannot breathe normally because horses depend almost entirely on nasal airflow. (PMC)

Severe Systemic Disease

Resuscitation may also be required later in the neonatal period because of:

• Sepsis

• Hypoglycaemia

• Hypothermia

• Severe metabolic acidosis

• Electrolyte abnormalities

• Haemorrhage

• Primary lung disease

• Congenital heart disease

• Cardiac tamponade

The chance of sustained survival is generally lower when cardiac arrest occurs as a consequence of advanced systemic disease rather than during the immediate transition after birth. (PMC)

How Worried Should You Be?

Normal Transition

The foal:

• Moves and breathes within seconds

• Establishes regular breathing

• Has a heart rate above 60 and rising

• Has pink gums

• Responds to the mare and surroundings

• Develops a strong suckle reflex

What to do: allow bonding, continue close observation and arrange the routine newborn veterinary examination.

Respiratory Emergency

The foal:

• Has a heartbeat above 60

• Is not breathing

• Is only gasping

• Does not respond to drying and rubbing

What to do: begin assisted ventilation immediately and call the veterinarian. Chest compressions are not yet required if the heart rate remains strong and rising.

Critical Bradycardia

The foal:

• Has a heart rate below 60

• Is not breathing normally

• Remains limp

• Shows no improvement after ventilation

What to do: ensure effective ventilation, reassess after approximately 30 seconds and begin compressions if the rate remains below 60 and is not rising.

Cardiopulmonary Arrest

The foal:

• Has no heartbeat

• Has no effective pulse

• Is not breathing

• Is unresponsive

• Has grey or blue gums

What to do: begin full CPR immediately, combining ventilation with chest compressions.

Resuscitated but Still High Risk

The foal:

• Is now breathing but remains weak

• Cannot stand or nurse

• Has abnormal breathing effort

• Is hypothermic

• Appears confused or neurologically abnormal

• Has an irregular heart rate

• Has milk or fluid at the nostrils

What to do: continue support and arrange urgent neonatal assessment or referral. Starting to breathe does not mean the emergency is over.

What Happens After the Foal Starts Breathing?

Every foal that required resuscitation needs veterinary examination.

Post-resuscitation complications may develop over the following hours, including:

• Neonatal encephalopathy

• Seizures

• Aspiration pneumonia

• Persistent pulmonary hypertension

• Hypoglycaemia

• Low blood pressure

• Kidney injury

• Gastrointestinal dysfunction

• Failure of passive transfer

• Sepsis

• Rib fractures

• Hypothermia

Foals recovering from asphyxia may have impaired thermoregulation and should be dried thoroughly, placed on clean dry bedding and provided with safe supplementary warmth where needed. (Merck Veterinary Manual)

The veterinary assessment may include:

• Temperature

• Heart and respiratory rates

• Oxygen saturation or blood-gas testing

• Blood glucose

• Lactate

• Blood pressure

• Neurological examination

• Thoracic ultrasound

• Rib assessment

• Serum IgG

• Complete blood count

• Kidney and electrolyte monitoring

• Evaluation of the placenta and foaling history

A foal that has been resuscitated successfully on a farm is still a strong candidate for referral because hypoxic injury may become apparent later. (IVIS)

Do Not Feed Until Swallowing Is Safe

Do not immediately bottle-feed a weak or recently resuscitated foal.

The foal must have:

• A strong suckle reflex

• Coordinated swallowing

• Normal tongue movement

• No coughing

• No milk or fluid coming from the nostrils

• Adequate alertness

Force-feeding a neurologically abnormal or weak foal can cause milk aspiration and pneumonia. Milk may need to be delivered through a correctly placed feeding tube by the veterinarian, or intravenous nutrition may be required in severely compromised foals. (PMC)

Colostrum remains time-critical, but it must be delivered safely. Once the foal is stable, the veterinarian should establish a colostrum, IgG and nutrition plan.

What Should You Do With the Umbilical Cord?

Allow the umbilical cord to break naturally when the mare rises where possible.

Do not routinely cut, clamp or tie the cord immediately after birth. Natural separation occurs at a narrowed point and allows the internal vessels to retract.

If the stump is bleeding excessively, a temporary clamp or clean umbilical tape may be required. Once the foal is stable, the stump should be treated using the farm veterinarian’s recommended antiseptic protocol. (Merck Veterinary Manual)

Breathing takes priority over dipping the umbilicus. Do not lose thirty critical seconds looking for chlorhexidine while the foal is apnoeic.

What Not to Do During Foal Resuscitation

Do Not Suspend the Foal by Its Hindlimbs

This delays ventilation, places pressure on the diaphragm and does not effectively drain the lungs.

Do Not Slap or Strike the Foal

Firm towel rubbing provides appropriate tactile stimulation without unnecessary trauma.

Do Not Suction Aggressively

Prolonged suction can worsen oxygen deprivation and slow the heart through a vagal reflex.

Do Not Overventilate

Very rapid or forceful breaths can damage the lungs, inflate the stomach and reduce blood return to the heart.

Do Not Begin Chest Compressions Automatically

If the foal has a strong heartbeat but is not breathing, ventilation is the immediate priority.

Do Not Force a Bottle Into a Weak Foal

Poor swallowing can lead to aspiration pneumonia.

Do Not Give Respiratory Stimulants Instead of Ventilation

Doxapram does not reverse secondary apnoea and is not recommended as a substitute for establishing an airway and breathing for the foal. Atropine is also not routinely appropriate because neonatal bradycardia is usually caused by hypoxia. (Merck Veterinary Manual)

Do Not Give Emergency Drugs Without Veterinary Direction

Epinephrine and other advanced resuscitation medications require correct indication, dosage, route and ongoing high-quality CPR. They are not the first step.

Do Not Assume One Breath Means Success

Continue monitoring until spontaneous breathing and circulation are regular and sustained.

What Should Be in a Foaling Emergency Kit?

A practical farm kit should include:

• Multiple clean towels

• A working stethoscope

• A watch, timer or clock with seconds

• A bulb syringe

• Clean gloves

• A bright headlamp or torch

• A correctly sized foal resuscitation bag and mask

• A protective barrier for mouth-to-nose ventilation

• An umbilical clamp or clean umbilical tape for active bleeding

• Veterinary-approved umbilical antiseptic

• Thermometer

• Written newborn milestones

• A laminated CPR algorithm

• Your veterinarian’s emergency number

• The referral hospital’s number and directions

• A charged phone

• A ready and accessible trailer

Breeding farms with trained personnel may also maintain:

• Appropriate nasotracheal tubes

• Syringes for inflating tube cuffs

• Portable oxygen

• Flow meter

• Intravenous catheters

• Veterinary emergency medication

• A printed drug and equipment checklist

The kit should be inspected before every foaling season. Check seals, battery life, oxygen supply, cleanliness and expiry dates. (IVIS)

The time to discover that the resuscitation bag is missing its mask is not while the newborn foal is turning blue.

Common Mistakes During Newborn Foal CPR

Mistake 1: Waiting Too Long to Ventilate

A foal that continues gasping is not breathing effectively. Begin assisted ventilation rather than repeatedly rubbing it for several minutes.

Mistake 2: Starting With Chest Compressions

Respiratory arrest usually precedes cardiac arrest in newborn foals. Effective ventilation may restore the heart rate without compressions.

Mistake 3: Using Excessive Ventilation Pressure

The newborn lungs are vulnerable. Deliver only enough air to produce gentle chest rise.

Mistake 4: Spending Too Long Checking for a Pulse

Take no more than approximately 10 seconds. If there is no heartbeat or effective pulse, begin compressions.

Mistake 5: Forgetting Existing Rib Fractures

Foals can sustain rib fractures during normal or difficult delivery. Quickly check if possible, but do not withhold necessary compressions from a pulseless foal.

Mistake 6: Stopping Once the Foal Takes a Breath

The foal may relapse into apnoea or remain hypoxic, hypoglycaemic or neurologically abnormal.

Mistake 7: Feeding Before Checking the Suckle and Swallow

A weak foal may inhale milk even when it appears eager to suck.

Mistake 8: Having Equipment but No Training

A bag, tube and oxygen cylinder are useful only when someone knows how to assemble and use them quickly.

How Can You Prepare Before Foaling?

Identify High-Risk Mares

High-risk pregnancies include mares with:

• Placentitis

• Premature udder development

• Vaginal discharge

• Twins

• Previous dystocia

• Previous red bag delivery

• Severe maternal illness

• Abnormal placental findings

• Premature labour

• Prolonged gestation with fetal concerns

• Planned caesarean section

These mares are safer foaling under experienced supervision, and some should be referred to an equine hospital before labour.

Cornell recommends against unattended home foaling when the pregnancy is high-risk, the owner is inexperienced or around-the-clock monitoring cannot be provided. (Cornell Vet College)

Practise the Emergency Plan

Before the expected foaling date:

• Assemble the resuscitation equipment

• Practise fitting the mask to a model

• Review heart-rate assessment

• Rehearse the ventilation and compression sequence

• Assign staff roles

• Confirm the veterinary call procedure

• Know where the nearest neonatal referral facility is

• Ensure the trailer is ready

Hands-on training with an equine veterinarian is far more valuable than reading instructions for the first time during an emergency.

Attend the Foaling

Mares should be monitored closely enough that dystocia, red bag delivery and a non-breathing foal are recognised immediately.

Record:

• Time the water breaks

• Time the foal is delivered

• First breath

• Heart rate

• Time standing

• Time nursing

• Placental passage

Accurate timings help the veterinarian assess the foal and identify delayed milestones.

Will the Foal Survive?

The outcome depends on:

• How long the foal was deprived of oxygen

• Whether ventilation began before cardiac arrest

• The cause of the problem

• Whether there is severe congenital disease

• Whether meconium was aspirated

• Whether multiple organs were injured

• The speed and quality of post-resuscitation care

The encouraging point is that almost 90% of newborn foals needing immediate resuscitation may respond to ventilation without requiring chest compressions or advanced drug treatment. (Merck Veterinary Manual)

The prognosis becomes more guarded when:

• Cardiac arrest has already occurred

• The duration of hypoxia is unknown

• High-quality CPR was delayed

• There is no response after 10 to 15 minutes

• Severe prematurity is present

• The foal has congenital airway or cardiac disease

• Sepsis or multiorgan failure is present

• Mechanical ventilation is required

• Severe neonatal encephalopathy develops

A foal that begins breathing after resuscitation may still recover fully, but it needs careful observation and veterinary support. The first successful breath is the beginning of treatment, not the end of it.

FAQs About CPR in Newborn Foals

Should I perform chest compressions if the foal is not breathing?

Not automatically. If the foal has a heartbeat above 60 beats per minute, prioritise assisted ventilation. Begin compressions if there is no heartbeat, the rate is below 40, or it remains below 60 and is not increasing after effective ventilation.

Can I use mouth-to-nose breathing on a foal?

Yes, as an emergency fallback when no resuscitation bag or endotracheal tube is available. Close the opposite nostril, keep the mouth closed and deliver only enough air to produce gentle chest rise.

How fast should I ventilate a newborn foal?

Approximately 10 breaths per minute is generally recommended during assisted ventilation. Avoid rapid or forceful breaths.

How fast should chest compressions be?

Provide approximately 80 to 120 compressions per minute, aiming close to 100, while allowing full chest recoil.

How long should CPR continue?

If there is no heartbeat, spontaneous breathing or other meaningful response after approximately 10 to 15 minutes of high-quality CPR, successful resuscitation becomes unlikely. The decision to stop should ideally involve the veterinarian.

Does a foal need a veterinarian after successful CPR?

Yes. A resuscitated foal remains at risk of delayed brain, lung, kidney, gastrointestinal and cardiovascular complications, as well as inadequate colostrum intake and sepsis.

Final Thoughts

Newborn foal resuscitation is primarily about oxygen.

The foal may still have a heartbeat, but without breathing, that heartbeat will not continue for long.

The essential sequence is:

1. Remove the membrane.

2. Open and clear the airway.

3. Rub and dry the foal.

4. Assess the heartbeat quickly.

5. Begin assisted ventilation if breathing does not start.

6. Add chest compressions only when circulation is absent or remains dangerously slow.

7. Continue support until breathing and circulation are stable.

8. Arrange immediate veterinary assessment after resuscitation.

Do not hang the foal upside down. Do not waste time with prolonged suction. Do not force-feed a weak foal. Do not mistake gasping for normal breathing.

Most importantly, prepare before the mare foals.

A written plan, working equipment and a few minutes of practical veterinary training can be the difference between watching helplessly and giving the foal a genuine chance.

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ASK A VET™ can help you prepare a foaling emergency checklist and organise the information your veterinarian will need, but a non-breathing newborn foal requires immediate hands-on resuscitation and emergency veterinary care.