"Foals" encompasses a stage in the lifecycle of equines with distinct physiological and developmental characteristics. Foals are young horses, typically under one year of age, undergoing rapid growth and development. They require specific nutritional, health, and management practices to support their transition to adulthood. This page compiles peer-reviewed research studies and scholarly articles that explore the growth, development, health challenges, and management practices associated with foals and horses, providing insights into their care and welfare across different life stages.
Genchi C, Malnati G.Strongyloides westeri larvae transmission by mare milk in foals has been studied; the results show the importance of this route for parasite penetration.
Sutoh M, Saheki Y, Ishitani R, Inui S, Narita M, Hamazaki H, Yokota T.This is the first report on Eimeria leuckarti infection in foals in Japan. Seven Thoroughbred or Angloarabian foals 2 to 7 months of age raised in the Hidaka district, Hokkaido, were infected with E. leuckarti. They died of severe alterations caused by the larval migration of Strongylus vulgaris, and were examined over a period from 1970 to 1973. Protozoa of this species were observed in the small intestine in all the foals. They were found mostly in vacuoles of the cytoplasm of monoclear cells in the lamina propria at or near the tip of villi. Various stages of gametocytes, oocysts, and micro...
Blakeslee JR, Olsen RG, McAllister ES, Fassbender J, Dennis R.Five horses were experimentally exposed to equine herpesvirus 2 strain LK. Two young foals developed chronic pharyngitis (98 and 232 days, respectively). Growth characteristics, cytopathic effects (CPE), inclusion body formation, ether sensitivity, and immunofluorescent analysis indicated that the virus recovered from infected animals was a herpesvirus serologically identical with, or at least antigenically related to EHV-2 strain LK. No significant complement-fixing (CF) or virus-neutralizing (VN) antibody responses were observed in adult horses while both foals demonstrated a rise in CF anti...
Sharma OP.The concentrations of PGF-2alpha in the peripheral blood of five foaling mares were measured by radioimmunoassay. Low levels of PGF-2alpha were detected as early as 1 week before foaling in two of the mares. These levels increased steadily, reaching a peak (1-74 +/- 0-44 ng/ml) during fetal expulsion. A relatively high PGF-2alpha level was found in samples collected 60 min after foaling.
White NA, Wheat JD.Proximal tibial epiphyseal fractures in 2 foals were reduced and stabilized by expansion and compression between 2 transversely placed Steinman pins, one on each side of the fracture. A Charnley apparatus or turnbuckles placed between the pins on each side of the fracture provided the mechanical advantage for repositioning the fracture fragments and achieving rigid fixation during healing. A light cast was applied over the fixation apparatus, keeping the limb in an extended position. The cast and fixation apparatus were removed after 4 weeks. The technique allowed rapid healing and adequate am...
Roberts MC.Lactase and cellobiase were detectable in the fetal intestine by the 3rd month of gestation, and although there was little change by the 9th month, maximal levels were reached at birth and steadily declined after 4 months. Conversely maltase, sucrase and trehalase were barely discernible in the fetus, maltase being present at low levels at birth, but all increased during the suckling period to attain adult levels by 7 months of age. Alkaline phosphatase activity matured earlier than did disaccharidase activity. Mucosal enzymes other than alkaline phosphatase were virtually absent from meconium...
Pattle RE, Rossdale PD, Schock C, Creasey JM.The development of the lung from the glandular through the canalicular to the alveolar stages in the horse fetus is described. Traces of surfactant and occasional lamellated osmiophilic bodies representing intracellular surfactant were found at 150 days of gestation, some 40 to 60 days before the transition to the canalicular stage. During this transition some of the cuboidal cells of the glandular rosettes are transformed into cells of Types I and II, but the surfactant is not fully developed until 300 days or, in some foals, until after delivery.
Johnson P, Rossdale PD.This paper describes preliminary experiments designed to test the hypothesis that cerebral damage is caused by cardiovascular events involving explosive changes in cerebral blood flow during birth. These events may be responsible for the convulsive episodes of foals suffering from the neonatal maladjustment syndrome.
Laing JA, Leech FB.In a group of 852 Thoroughbred mares, 69-7% had foals which survived beyond 6 weeks, 7-1% had dead, premature or full-term foals and 1-1% had foals which died within 6 weeks after birth. Possible factors which may have influenced these data are mentioned.
Trexler PC, Thomson GR.A method of rearing germ-free gnotobiotic foals is described. To date, four foals have been infected with rhinopneumonitis and the only clinical signs of infection have been a transient fever and leukopaenia; no detailed results are, as yet, available.
Klug E, Treu H, Hillmann H, Heinze H.Artificial insemination using deep-frozen semen was performed on 116 mares in 1973 using twelve ejaculates from eight stallions of the Hanoverian breed. Despite the fact that the quality of the semen used was poor, the majority of the mares inseminated were subfertile and some mares were inseminated during one oestrus only, 44% nevertheless conceived and gave birth to live foals. Of a small group of ten mares inseminated in the same year with fresh semen, seven conceived.
Jeffcott LB.The mechanism of transfer of maternal immunity to the foal is reviewed. Maximal efficiency of macromolecular absorption by specialized cells of the small intestine exists soon after birth. The absorptive cells are progressively replaced by more mature-looking cells incapable of taking up large molecules and the rate of absorption is reduced in a linear decline and ceases completely within 24 hr. Passive antibody levels fall rapidly in the first 4 weeks of life to less than half their original values and have usually completely disappeared by 6 months of age. The foal shows immunological compet...
Arvidson G, Astedt B, Ekelund L, Rossdale PD.Phospholipids in embryonic lung tissue, pulmonary washings and amniotic fluid were measured to study the development of lyng surfactant in the horse. A significant increase in the concentration of total phospholipids in lung tissue and a concomitant rise in the amount of dipalmitoyl lecithin in amniotic fluid between 100 and 150 days of gestation indicated the initial formation of surfactant in the fetal lung during this period.
Erbsloh JK.A short account is given of babesiosis (equine biliary fever) caused by the tick-borne protozoan Babesia equi and B. caballi, endemic in the Cape Province of South Africa. The clinical picture, diagnosis and treatment are described. In the absence of any prophylactic measures, prognosis is poor; control of the parasites in the tick-infested areas is essential.
Parker WG, Sullivan JJ, Larson LL.The diagnostic value of rectal palpation and immunological assay of PMSG was tested at different stages of pregnancy in mares inseminated with frozen semen in three separate studies. The results were based on foaling success and particular attention was paid to the numbers of inconsistent results obtained by the two tests. Generally, the number of false positive diagnoses was lower for the immunological assay than for palpation in early pregnancy (Days 40 to 60) and the relationship became reversed later in gestation.
Littlejohn A.The arterial oxygen tension (PaO2) in clinically normal newborn foals at 1300 m above sea-level is considerably lower (less than 60 mmHg) than in similarly aged foals at lower altitudes. This figure is further reduced to less than 50 mmHg without adverse effect in newborn foals at 1300 m maintained under pentobarbitone anaesthesia for prolonged periods. Measurement of O2 dissociation curves indicates that haemoglobin becomes saturated at a lower blood O2 tension in newborn foals than adult horses.
Lovell JD, Stabenfeldt GH, Hughes JP, Evans JW.The levels of progesterone and total progestins increased during late pregnancy and then fell dramatically during the last few days before parturition, although birth occurred in the presence of significant amounts of plasma progesterone. Oestrogen levels decreased slowly but insignificantly until birth occurred, and then remained at a low level until the post-partum oestrus 10 to 12 days later. Total 11beta-hydroxycorticosteroids were unchanged from Day 45 before to Day 15 after birth. The endocrine pattern of one ovariectomized pregnant mare during the last month of gestation was similar to ...
Morgan DO, Bryans JT, Mock RE.The foal is born without detectable antibody and except for small amounts of IgM is devoid of immunoglobulins. Intrafetal administration of either Venezuelan equine encephalomyelitis virus (VEE-TC83) or ovine erythrocytes elicited IgGa, IgGb and a trace of IgG(T). The fetal blood VEE-TC83 neutralization titre was higher than the neutralization titre elicited by the same preparation in older horses.
Whitwell KE.A brief description is given of the morphology of the umbilical cord and some variations encountered. In 95% of normal Thoroughbred foals the cord measures less than 84 cm. Factors which govern cord length are not known. Seven pathological conditions involving the umbilical cord are described. Increased length is the most common abnormality and predisposes to three potentially lethal conditions, strangulation of the cord around the fetus, excessive torsion, and allantochorionic necrosis at the cervical pole.
Osborne VE.Foaling figures for Thoroughbred mares in Australia show a puzzling disparity between conception and foaling rates in the second half of the 22 years of official data collection between 1950 and 1972. In the first 9 years of the survey, the live foal percentages rose in parallel with conception rates, but then a divergence of the figures occurred with the conception rate continuing to improve by 6-25% while the foaling rate improved by only 0-01% over the same period. An hypothesis supported by data from two studs is considered that stress factors additional to those experienced by mares in th...
Within the veterinary world, data regarding the surgical management of hypospadias is lacking. Reports within equines have documented resective phallectomy procedures rather than urethral reconstruction. This case report documents the first ever urethroplasty for an equine hypospadias, performed by a consultant paediatric surgeon. The urethroplasty was achieved by applying the same surgical principles mastered from paediatric urology to a horse. The indication for surgery was contact dermatitis of the hind-leg, which impaired the thoroughbred foal's racing potential. Methods: A single stage ur...
Muñoz L, Sepúlveda-Calderón P, Villaguala-Pacheco C, Aqueveque CL.The aim of this research was to assess the copro-prevalence of Fasciola hepatica in owned Chilean breed horses (Equus caballus) residing in the province of Concepción, Chile. The study was carried out throughout October 2017. Samples were taken from all (100%) Chilean breed horse (124 specimens; 45 females and 79 males, aged between 7 months and 24 years old) from the Concepción province. A rectal stool sample was obtained from each animal. This was analyzed using the Army Medical School method (AMS III) technique to detect F. hepatica eggs. Information about the horse's age, sex, previous f...
Berlin D, Steinman A, Raz T.The aim of this prospective study was to investigate possible endocrine components to foal rejection behaviour in post-partum Arabian mares. Arabian mares were divided into two groups based on their maternal behaviour: (1) mares with normal post-parturient behaviour (8 mares); and (2) mares that demonstrated foal-rejecting behaviour post-partum (15 mares). Most mares were visited and sampled twice, in the first and third days post-partum. Serum samples were used for measurement of progesterone, oestradiol and prolactin concentrations. There were no statistically significant differences in oest...
Zicker SC, Rogers QR.Temporal changes, as well as differences in distribution, in concentrations of 24 amino acids in plasma and whole blood of neonatal foals were determined from birth to 2 days of age. In addition, differences in concentrations of amino acids in plasma between mare and foal pairs were determined at birth. Significant (P < 0.05) hypoaminoacidemia existed for 15 amino acids in plasma of foals at birth, compared with mares (paired t-test). Concentrations of 7 amino acids (aspartate, glutamate, glutamine, glycine, hydroxyproline, phenylalanine, proline) in plasma of foals were higher (P 0.05). S...
Szeredi L, Makrai L, Dénes B.The first objective of this study was to develop an immunohistochemical procedure for rapid detection of Rhodococcus equi in impression smears from affected organs of foals on postmortem examination. The second aim was to demonstrate whether R. equi can be detected in smears of tracheal exudates collected from the same foals using an immunohistochemical method. Impression smears and cryostat and paraffin-embedded sections were made from the lungs and mediastinal lymph nodes of three foals (A, B and C) that had died of respiratory disease caused by R. equi, and also from the caudal mesenteric l...
Sigler DH, Ericson DE, Gibbs PG, Kiracofe GH, Stevenson JS.Lactating mares were assigned as controls or fed altrenogest (.044 mg.kg body wt-1.d-1) for 15 d after foaling. Mares (n = 6) fed altrenogest were inseminated during the first estrus after treatment and mares (n = 6) in the control group were inseminated during the second postpartum estrus. Ovulation during the estrus in which mares were inseminated occurred 26 +/- 1 d postpartum for treated mares and 36 +/- 1 d postpartum for control mares. The percentage of mares conceiving was not different for control (67%) and alternogest-treated (100%) mares. No differences were observed in tone and size...
Dudan F, Hirni H.Since 1980 techniques specifically designed to treat human neonatal diseases have also started to be applied to ill or premature equine newborns. These techniques will be described and their application to the most common equine neonatal disorders will be discussed. Such techniques include: post-natal cardiopulmonary resuscitation, exogenous thermal support, administration of broad spectrum antibiotics after diagnostic studies, supplemental oxygen therapy and mechanical ventilation, intravenous fluid and electrolyte therapy, blood component transfusion and total parenteral nutrition.
Matsumura T, Mashiko R, Sato T, Itokawa K, Maekawa Y, Ogawa K, Isawa H, Yamamoto A, Mori S, Horita A, Ginnaga A, Miyatsu Y, Takahashi M, Taki H....The redback spider (Latrodectus hasseltii Thorell) reportedly invaded Japan in September 1995. To date, 84 redback spider bite cases have been reported; 7 of these cases employed the antivenom. Antivenom has been imported from Australia in the past, but because of restrictions on exportation it was evident that nearly all of the antivenom present in Japan would expire during 2014. In 2014, a plan was proposed to experimentally manufacture and stockpile a horse antiserum for ourselves, using redback spiders indigenous to Japan. A total of 11,403 female spiders were captured alive: 1,217 from th...
Thein P, Essich G.An investigation was carried out upon occurrence and course of infectious and non infectious diseases as well as the mortality in foals born and raised at the State Stud Marbach/Lauter between 1982 and 1991. The foals have been investigated from birth to weaning, they consisted of 177 Thoroughbred Arabians and 285 German Warmblood foals (total 462 foals). The diseases were divided into pre-, peri- and postnatal according to their known or assumed cause and onset. There was a preponderance of prenatal diseases (11.25%) whereas the perinatal rate was 1.30% and the postnatal rate of diseases was ...
Shibahara T, Kuwano A, Ueno T, Anzai T, Kuwamoto Y, Sato H, Maeda T, Ishikawa Y, Kadota K.A 21-month-old Thoroughbred colt showed continuous diarrhea and developmental retardation for 7 months, and was thereafter subjected to euthanasia for necropsy and laboratory examinations. At necropsy, the cecal and colonic mucosae were diffusely rough and hyperemic. Histopathologically, the mucosa and submucosa were edematous and were infiltrated by numerous lymphocytes and macrophages. Meanwhile, three morphological types of Brachyspira antigen-containing spirochetes were found to be numerous in the crypts and in the mucus layer over the epithelium in the cecal and colonic lesions. They were...
Knych HK, Steffey EP, Mitchell MM, Casbeer HC.The use of fentanyl is limited in adult horses, in part due to potential for central nervous system excitation. The pharmacokinetics and the plasma concentration-related behavioural actions of fentanyl have not been described for young foals. The goal of the present study was to describe the pharmacokinetics and behavioural effects of fentanyl following administration to the same group of foals at 3 different ages. Experimental study in healthy foals. Fentanyl was administered i.v. (4 μg/kg bwt) to a group of 9 foals on 3 separate occasions at 6–8, 20–22 and 41–42 days of age. Blood sam...
Yarbrough TB, Voss E, Herrgesell EJ, Shaw M.To report the clinical signs and management of 4 foals with persistent frenulum of the epiglottis. Methods: Case report. Methods: Four newborn foals. Methods: Foals were admitted with a complaint of oronasal reflux after nursing. Variable systemic signs of aspiration pneumonia were evident. Nasal endoscopy confirmed persistent dorsal displacement of the soft palate. Persistent frenulum of the epiglottis, confirmed by oral endoscopic examination, was transected. Results: After surgery, all foals had the epiglottis positioned normally, dorsal to the soft palate. Clinical signs of oronasal reflux...
Sanclemente JL, Rivera-Velez SM, Horohov DW, Dasgupta N, Sanz MG.Foals that develop pulmonary ultrasonographic lesions on Rhodococcus equi (R. equi) endemic farms are treated with antibiotics because those at risk of developing clinical pneumonia (~20%) cannot be recognised early. Candidate biomarkers identified using metabolomics may aid targeted treatment strategies against R. equi. Objective: (1) To describe how foal ageing affects their plasma metabolome (birth to 8 weeks) and (2) to establish the effects that experimental infection with Rhodococcus equi (R. equi) has on foal metabolome. Methods: Experimental study. Methods: Nine healthy newborn foals...
Respiratory diseases are a major cause of morbidity and mortality in the horses of all ages including foals. There is limited understanding of the expression of immune molecules such as tetraspanins and surfactant proteins (SP) and the regulation of the immune responses in the lungs of the foals. Therefore, the expression of CD9, SP-A and SP-D in foal lungs was examined. Results: Lungs from one day old (n = 6) and 30 days old (n = 5) foals were examined for the expression of CD9, SP-A, and SP-D with immunohistology and Western blots. Western blot data showed significant increase in the...
Furness JB, Poole DP.The functioning of the gastrointestinal tract is under the control of the most extensive system of peripheral neurons in the body, the enteric nervous system, and the largest endocrine system of the body, the GEP endocrine system. The enteric nervous system in large mammals contains 500 million neurons, and the GEP endocrine system produces more than 30 hormones. Numerous enteric neuropathies affecting both humans and animals have been described and digestive disorders affect commercially important species, such as horses and cattle. The most severe enteric neuropathies (e.g., lethal white syn...
van Niekerk HP, Couvaras S.The possibility of including sodium hydroxide-treated lucerne hay as a constituent in rations for horses was investigated by measuring its effect on the performance and certain bloodcomponents of growing foals. As no adverse effects were found it is concluded that further investigation is necessary to see whether the inclusion of low grade-treated roughages in the ration of horses would be of economic significance.
Doreau M, Dussap G.Female milk production was related to offspring water turnover, estimated by a tracer method (fig. 1). After deuterium oxide was injected into the blood of the offspring, we measured the decrease of its concentration in time. Milk intake was calculated by equations taking into account the weight gain of the offspring. The reliability of this method was checked in 28 bottle-fed lambs with known milk intake; the correlation between the actual intakes and our estimates was 0.98 with an error means of 5.6 p. 100. The error on the mean of 28 lambs was 0.5 p. 100 (table 1). The milk production of 6 ...
Sirois J, Betteridge KJ, Brault A.Embryo transfer was used in an equestrian teaching center in order to produce as many foals as possible from their preferred mares during a single breeding season. Embryo collection by uterine lavage was attempted in five donor mares on 25 occasions 6.5 days after ovulation. Sixteen of the collection attempts (64%) yielded a total of 17 blastocysts. Of these 17 embryos, 13 were immediately transferred transcervically into recipient mares that had ovulated within two days of the time of ovulation in the donors, three were frozen for later transfer, and one was lost. Eight of the freshly transfe...
Castro LA, Brown MP, Gronwall R, Houston AE, Miles N.Six foals from 6 to 8 weeks of age were given a single oral dose of rifampin at a dosage of 10 mg/kg of body weight. Serum rifampin concentrations were measured serially during a 24-hour period. The mean peak serum rifampin concentration was 6.7 micrograms/ml at 4 hours after treatment. The concentration decreased slowly, and at 24 hours the mean value was 2.7 micrograms/ml. The elimination half-life was 17.5 hours, and the elimination rate constant was 0.04/hr.
Koterba AM, Drummond WH.Provision of adequate nutritional support to the sick neonatal foal is a vital part of intensive care; frequently, however, it is very difficult to accomplish. In this article, current recommendations concerning both enteral and parenteral nutrition are discussed.
Gånheim A, Gånheim A, Jöchle W.In a blinded trial, the effectiveness and safety of 2.2 mg of the GnRH analog deslorelin acetate, administered in a short-term implant (STI) to normally cycling mares in estrus with a dominant ovarian follicle of 30 mm in diameter or larger, were evaluated, using a placebo implant as a negative control. A total of 39 mares received treatments at admittance with pre-randomized implants containing either 2.2 mg or 0 mg deslorelin. Mares were teased daily and examined rectally with ultrasound at 24 h intervals to determine time to ovulation and duration of estrus. The number of breedings and the ...
Mouncey R, Arango-Sabogal JC, de Mestre AM, Foote AK, Verheyen KL.Enhanced understanding of reasons for, and timings of, mortality in Thoroughbreds prior to entering race training is warranted to provide insight into this population's health status. The aims of this study were to describe pathologies diagnosed at post-mortem (PM) examination in Thoroughbreds aged from birth to 18 months and investigate associations between age and pathology. Reports from a pathology laboratory in Newmarket, UK, were used to identify eligible cases examined between January 2006 and December 2020. Reported pathologies were extracted and categorised where appropriate. Comorbidi...
Tennent-Brown BS, Morrice AV, Reed S.Neonatal encephalopathy is the most common neurologic condition affecting newborn foals and shares similarities with perinatal asphyxia syndrome of human infants. In many cases of neonatal encephalopathy there is no obvious episode of acute or chronic hypoxia and other mechanisms likely play a role in the pathogenesis. Increased concentrations of neuroactive progestagens are found in affected foals; whether these molecules are protective, as has been suggested, or play a role in the pathogenesis is unknown. Neurologic diseases other than neonatal encephalopathy affect foals occasionally and sh...
Knych HK, Steffey EP, White AM, McKemie DS.Tramadol is an analgesic agent used in man and a number of veterinary species. The pharmacokinetics and behavioural effects of tramadol and its active metabolite have been described in mature horses, but not in young foals. Objective: To characterise the pharmacokinetics, metabolism and some induced behavioural and physiological responses following i.v. tramadol administration in the same group of foals on 4 different occasions, from a few days after birth to age 43 days. Methods: Experimental. Methods: Tramadol was administered i.v. (3 mg/kg bwt) to a group of 8 foals on 4 separate occasion...
Antal A, Szabó I, Vajda G, Antal VD, Polner A, Totth B, Szollár I, Stipkovits L.Clinical, microbiological, haematological, and immunological investigations were carried out in mares and their foals of 2 studs. A considerable number of foals fell ill with pneumonia, the mortality rate was high. Mycoplasmas were mostly isolated from nasal swabs and from the lungs. The isolation rate of bacteria was lower. Serum IgG concentration was reduced in the diseased or dead foals compared to that of healthy animals, the data stress in importance of IgG in the development of respiratory diseases also in foals.
Mayinda GD, Serreau D, Gesbert A, Reigner F, Sutra JF, Lespine A, Sallé G.The management of equine strongyles has become problematic over the last decade because of an increased prevalence of drug-resistant isolates worldwide. Therapeutic options are therefore limited, leaving macrocyclic lactones as the most often effective drug class. However, their lipophilic properties result in a long-lasting elimination that could favour drug resistance selection. As a result, ivermectin treatment in lactating mares could promote suboptimal exposure of their foal parasites to ivermectin, thereby selecting for more resistant worms. To test for this putative transfer, we selecte...
Dunlop CI.Physiologic similarities and differences between foals and adult horses, including response to pain, cardiopulmonary function, ability to compensate for dehydration and hemorrhage, and response to anesthetic drugs, are considered in this article. Preanesthetic evaluation, choice of anesthetic drugs, technique, and monitoring support requirements through to anesthetic recovery are based on these physiologic considerations. Anesthetic techniques discussed include drugs for premedication, parenteral or inhalational anesthetic induction, and maintenance using inhalational and parenteral anesthesia...
Ross MW, Stephens PR, Reimer JM.A 9-year-old pregnant Standardbred broodmare was evaluated for signs of mild abdominal pain, failure to defecate, and mild abdominal distention. Rectal examination revealed the leading edge of a small colon intussusception, and peritoneal fluid analysis indicated suppurative peritonitis. Surgical management, including reduction of the intussusception and small colon resection with end-to-end anastomosis, resulted in successful outcome (1-year follow-up evaluation). Postoperative complications including dehiscence of the ventral midline surgical incision and simple obstruction at the anastomosi...
Starick E.A reverse transcription-polymerase chain reaction (RT-PCR) assay using four different primer pairs for the detection of equine arteritis virus (EAV) RNA in semen and tissue samples was evaluated. A fragment encoding the leader sequence of the EAV genome was most successfully amplified. The specificity and sensitivity of RT-PCR was assessed by virus isolation in cell culture, restriction analysis, dot blot hybridisation and nested PCR. To this end, 23 semen samples from seropositive stallions and 11 tissue samples from 4 aborted foals were tested. Compared to the virus isolation test in cell cu...
Pintore MD, Cantile C.A full-term male foal born in a farm holidays in Maremma (Tuscany, Italy) was euthanized shortly after birth due to the presence of several malformations. The rostral maxilla and the nasal septum were deviated to the right (wry nose), and a severe cervico-thoracic scoliosis and anus atresia were evident. Necropsy revealed ileum atresia and agenesis of the right kidney. The brain showed an incomplete separation of the hemispheres of the rostral third of the forebrain and the olfactory bulbs and tracts were absent (olfactory aplasia). A diagnosis of semilobar holoprosencephaly (HPE) was achieved...
