Foal health: Managing neonatal maladjustment syndrome

Although rare, neonatal maladjustment syndrome can be a challenging and potentially serious condition for foals as they struggle to adapt to life outside the womb due to neurological abnormalities present during or shortly after birth.

The condition is characterized by a range of symptoms and risk factors, but understanding the possible causes behind NMS development is also crucial for early detection and intervention.

Dr. Amanda Trimble, a clinical assistant professor of equine internal medicine at the Texas A&M School of Veterinary Medicine and Biomedical Sciences, explores these causes so that owners can understand how the condition is treated by their veterinarian, improving the chances of a healthy outcome for their foals.

How does NMS develop?

The exact cause of NMS is not fully understood, yet its risk factors provide insight into theories that may explain what causes the condition to develop.

“One theory suggests that the condition is caused by a lack of blood flow and oxygen to the foal’s central nervous system during or shortly after birth,” Trimble explained. “Factors that can lead to a lack of blood flow and oxygen include: dystocia; cardiac, respiratory or placental issues such as red bag delivery where the outer layer of the placenta does not burst; umbilical cord compression; and in utero infections.”

Another theory says when foals experience the stress of a challenging pregnancy or birth, their brains can produce varying amounts of neurosteroids, or small molecules in the brain that help messages move between brain cells and influence how the brain reacts to the world. These neurosteroids disrupt how brain cells normally communicate and make it harder for foals to “wake up” and adjust to their new surroundings when born.

“Normally the passage through the birth canal signals in foals to ‘wake up’ from being in utero shortly after birth, but when the passage is altered, such as with C-section deliveries, that signal never occurs, leading to a high neurosteroid concentration,” Trimble explained. “This high concentration, we think, leads to a persistent ‘sleepy’ state after birth, similar to being in the womb.”

Treatment overview

One specific treatment approach for NMS is the Madigan Squeeze, developed by Dr. John Madigan at the University of California, Davis, which mimics the pressure experienced in the birth canal that is believed to signal a foal to wake up after birth. It involves applying pressure over the ribs for 20 minutes using ropes, replicating the time it takes for a foal to pass through the birth canal. It is similar to swaddling a human infant.

“This procedure should only be performed on foals undergoing veterinary care, as candidate selection is important for safety considerations,” Trimble said. “One report showed foals that have been squeezed were 3.7 times more likely to recover, and foals that are squeezed generally recover more quickly.”

In general, however, treatment strategies for NMS rely on managing the symptoms of the condition, and regular monitoring by a veterinarian will be essential to assess the foal’s progress and adjust treatment as needed. Some foals also have concurrent illness or issues in addition to NMS, and should be under the care of a veterinarian, as foals can decline quite rapidly.

“Many foals with NMS completely recover within three to five days of initiating therapy, especially if they are not battling with a concurrent illness,” Trimble said. “Treatment focuses on providing supportive care to the foal by providing fluids, anti-inflammatories and oxygen supplementation; ensuring the foal receives adequate nutrition supplemented with antioxidants, such as vitamins C and E; and managing concurrent illnesses and seizures, if present, with appropriate medication.”

Timely intervention can significantly improve the chances of a positive outcome for foals affected by NMS, ensuring they can start their new life with the best possible health and well-being.

•••

Pet Talk is a service of the School of Veterinary Medicine and Biomedical Sciences, Texas A&M University. Stories can be viewed on the web at vetmed.tamu.edu/news/pet-talk. Suggestions for future topics may be directed to vmbs-editor@tamu.edu.