This article is from the October 2020 Horse Deals magazine.
Lisanne is a diplomate of the American College of Veterinary Internal Medicine, specialising in equine internal medicine. Originally from Prince Edward Island, Canada, she is now based out of Newcastle, NSW, at the Newcastle Equine Centre offering specialty services in all areas of equine internal medicine, but has a special interest in neonatal medicine, neurology, cardiology and critical care. During her free time, she can usually be found at the beach or hiking with her very silly Golden Retriever, Goose.
with Dr Lisanne Gallant, DVM, DACVIM (LA)
Neonatal maladjustment syndrome (NMS, aka dummy foal syndrome) is a common disorder of foals that has mystified equine veterinarians for decades. It is one of the most common reasons foals are admitted to veterinary hospitals for intensive care, as it can result in multiple life-threatening conditions. Foals affected by this disorder seem detached from the world, often wandering aimlessly with no affinity for their dam. One of the most problematic clinical signs of this syndrome is the lack of desire/ability to nurse, causing these foals to become very weak and very sick if not treated appropriately.
Why does it occur?
Causes for NMS have been speculated for years, however great advances have been made in recent years by veterinarian Dr John Madigan and his research team at the University of California (Davis). They’ve pinpointed a group of neurosteroids that are naturally elevated in foals in utero to keep them quiet and in a sleep-like state while in development. This protects the dam from overactive foals that could potentially cause harm to her reproductive tract, and potentially harming the foetus itself. When the foal is born, it is thought the pressure from the birth canal signals these neurosteroids to decrease and trigger the foal to “wake up” allowing it to stand and nurse appropriately soon after birth. In foals affected by NMS, these neurosteroids remain elevated even after birth, sometimes for as long as five to seven days. A similar process occurs in infants born by Cesarean section delivery and infants who do not receive skin to skin contact (also known as kangaroo mother care). The connection between these infants and NMS foals is fascinating and is currently an active area of research in both veterinary and human medicine.
The most common clinical signs in foals affected by NMS include disinterest in the mare, loss of the suckle reflex, aimless wandering, chewing or licking the walls, abnormal vocalisation, weakness, seizures. These clinical signs lead to failure of passive transfer if not recognised and addressed soon after birth. This occurs when the foal does not receive an adequate quantity or quality of colostrum from the dam within the first 8-12 hours of life, which contains essential antibodies to protect the foal from infection while its immune system develops over the initial 2-3 months of life. This condition leads to sepsis, which is life-threatening and can be fatal, even when treated aggressively.
One of the first steps in treating an NMS foal is investigating possible failure of passive transfer by checking blood immunoglobulin G (IgG) levels. If failure of passive transfer is confirmed, the foal will likely be treated with antimicrobials and hyperimmunised plasma (to prevent/treat infection and supply the foal with an exogenous source of IgG). If the foal is unable to nurse properly, an indwelling nasogastric tube will likely be placed in order to feed the foal either with the mare’s milk or milk replacer. This supportive care is essential for the foal until the NMS resolves and it begins nursing independently.
The Madigan Squeeze Technique
An adjunctive treatment has been introduced by Dr Madigan and his team through their extensive research. It is important to note this method is not to be used in place of the supportive care mentioned previously, but as an adjunctive therapy to ensure the best outcome. The research team speculated that by replicating the pressure from the birth canal around the foal’s thorax, they could stimulate the neurosteroids to decrease and trigger the foal to “wake up”. The “Madigan Squeeze Technique” was introduced, which essentially squeezes a foal to simulate going through the birth canal. This technique utilises a rope wrapped around the foal’s chest in a specific way, and gentle pressure is applied for 20 minutes. The foal is then allowed to “wake up” and is generally dramatically more interested in its dam and will begin to nurse within a few hours. However, every foal may respond to this differently. Some foals may even need repeated squeezes, and some foals may not respond at all if affected by other disease processes. This technique should only ever be performed under veterinary supervision after a foal has been thoroughly examined by a veterinarian.
We have been using this technique in our clinic for the past two years with generally good success. Some foals show a dramatic recovery after only one squeeze session. Before the Madigan Squeeze Technique, we would have been forced to wait for the foal to “wake up” which could have taken days, prolonging hospitalisation and the risk for complications.
The Madigan Squeeze Technique is truly an amazing phenomenon; however, it is imperative to note this technique is only appropriate for foals properly examined by a veterinarian and diagnosed with neonatal maladjustment syndrome. Foals can be affected by a variety of disorders that can easily be confused with this syndrome. If you think your foal may have NMS, it is crucial you contact your veterinarian, as your foal will need proper examination and supportive care to prevent the sequelae of NMS like failure of passive transfer and sepsis.
The Madigan Squeeze being preformed on a newborn foal with NMS.
Foals affected by NMS generally have a good prognosis if recognised and treated early and appropriately. If you notice any of the clinical signs associated with NMS in your foal, please contact your veterinarian right away to prevent life-threatening complications. As mentioned previously, it is also possible your foal may be suffering from other diseases that present similarly to NMS, so it is very important to contact your veterinarian as soon as you notice any abnormal signs. A good rule of thumb to follow when dealing with neonatal foals is the “1-2-3 Rule”. A healthy newborn foal should be standing unassisted within 1 hour of birth; nursing well by 2 hours of birth, and the mare should have passed her placenta with 3 hours of birth. If this timeline deviates at any point, contact your veterinarian immediately. We also recommend a general health check by your veterinarian within 24 hours of birth to check for any early signs of disease and to assess your foal’s blood IgG levels to ensure proper passive transfer has occurred.
If you’re expecting a foal this season, always be on the lookout for any of the clinical signs mentioned previously, or if your foal deviates from the “1-2-3 Rule” timeline. Early intervention and a strong partnership between you and your veterinarian will give your foal the best possible chance at a good outcome.
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