Survey of Veterinarians Using a Novel Physical Compression Squeeze Procedure in the Management of Neonatal Maladjustment Syndrome in Foals

SIMPLE SUMMARY: Neonatal foals must pass key milestones for survival such as standing and sucking from the mare shortly after birth. A condition known as neonatal maladjustment syndrome (NMS), or “dummy foal syndrome”, is characterized by failure to stand, suck, and follow their mare, putting them at risk of malnourishment, infection, and death. NMS had been presumed to be exclusively caused by low oxygen in the foal during the perinatal period. More recently, however, our group demonstrated the presence of neuroactive steroids in foals that exhibited the altered behavior and consciousness characteristic of the disorder. It has been hypothesized that signaling the transition from the in utero unconscious state to extrauterine consciousness may involve labor-induced physical compression (squeezing). During normal birth, foals experience such physical compression for approximately 20 min during stage-2 labor. Current medical treatments for NMS are symptomatic and supportive, which may require 2–7 days of veterinary care. Anecdotal evidence demonstrated that a novel physical compression (squeeze method) that applies 20 min of sustained pressure to the chest of neonatal foals exhibiting this syndrome might rapidly hasten recovery. This survey compares reported outcomes of medical therapy alone to this squeeze procedure with or without medical therapy. The results revealed some foals that received the squeeze procedure recovered faster than those that received medical therapy only. ABSTRACT: Horses are a precocious species that must accomplish several milestones that are critical to survival in the immediate post-birth period for their survival. One essential milestone is the successful transition from the intrauterine unconsciousness to an extrauterine state of consciousness or awareness. This transition involves a complex withdrawal of consciousness inhibitors and an increase in neuroactivating factors that support awareness. This process involves neuroactive hormones as well as inputs related to factors such as cold, visual, olfactory, and auditory stimuli. One factor not previously considered in this birth transition is a yet unreported direct neural reflex response to labor-induced physical compression of the fetus in the birth canal (squeezing). Neonatal maladjustment syndrome (NMS) is a disorder of the newborn foal characterized by altered behavior, low affinity for the mare, poor awareness of the environment, failure to bond to the mother, abnormal sucking, and other neurologically-based abnormalities. This syndrome has been associated with altered events during birth, and was believed to be caused exclusively by hypoxia and ischemia. However, recent findings revealed an association of the NMS syndrome with the persistence of high concentrations of in utero neuromodulating hormones (neurosteroids) in the postnatal period. Anecdotal evidence demonstrated that a novel physical compression (squeeze) method that applies 20 min of sustained pressure to the thorax of some neonatal foals with this syndrome might rapidly hasten recovery. This survey provides information about outcomes and time frames to recovery comparing neonatal foals that were given this squeeze treatment to foals treated with routine medical therapy alone. Results revealed that the squeeze procedure, when applied for 20 min, resulted in a faster full recovery of some foals diagnosed with NMS. The adjunctive use of a non-invasive squeeze method may improve animal welfare by hastening recovery and foal–mare interactions that minimize health problems. This would also avoid or reduce costs arising from hospitalization associated with veterinary and nursing care that sometimes leads owners to elect for euthanasia.