Equine Neonatal Maladjustment

Equine Neonatal Maladjustment

Breeders and veterinarians have described the condition known as equine neonatal maladjustment syndrome for many years. Foals with this condition are often disoriented relative to the environment and the mare, wander, do not seek the udder, and do not suckle. Many have metabolic problems such as failure of thermoregulation, gut motility, and reduced ventilation. 

In contrast, normal foals are active within 1-2 hours post birth and stay close to the mare and nurse within 3 hours. To see the difference in foals, watch the video on right.

We have found foals with neonatal maladjustment syndrome have a persistence and reversion to producing high levels of sedative neurosteroids post birth. These neurosteroids keep the foal asleep in the womb and prevent the foal from ‘galloping in utero’. These compounds are produced in fetus by the brain, and likely the adrenal glands. They act on the brain GABA receptor (similar to anesthetics) causing behavioral disturbances including, but not limited to, dissociation with the environment, lack of normal perception of fear, lack of maternal bonding, lack of normal nursing behavior, sleep disturbances and other behavioral abnormalities.

We conducted studies on the flopping reaction of newborn foals, a condition seen in all newborn foals when held tightly or squeezed, the foal rapidly collapses and appears to fall asleep. We created a squeeze procedure to study the reaction in normal newborns and found they enter slow wave sleep and have significant hormone changes when squeezed.
We wondered if the birth canal pressures on the foal - a tremendous squeeze for 20 minutes during stage 2 labor - might trigger the sedative neurosteroids to be lowered and signal that it is ok for the foal to be born and try to stand and nurse, etc. When presented with a foal with maladjustment which the owner said had a quick birth process (had not nursed within 8 hrs and did not recognize the mare), we applied the squeeze procedure. During the squeeze procedure the foal slept for 20 minutes and then upon awakening, walked over to the mare and started nursing. Go to this video to see the squeeze procedure: https://vimeo.com/68410389

Ongoing Studies

  • Retrospective clinical trial on use of squeeze for neonatal maladjustment syndrome
  • Prospective clinical trial on use of squeeze in field
  • Investigation of biomarker for diagnosis of neonatal maladjustment syndrome

Maladjusted Foal Stories from the Field

The Dummy Foal - a miniature horse report

Additional resources


Instructions to use the Madigan Foal Squeeze (pdf)

Survey of veterinarians using a novel physical compression squeeze procedure in the management of neonatal maladjustment syndrome in foals Animals 2017

Dummy Foal Syndrome (Equine Neonatal Maladjustment Syndrome) The Horse 2010

Aleman M, Weich K, Madigan JE. Survey of veterinarians using a novel physical compression squeeze procedure in the management of neonatal maladjustment syndrome in foals. Animals. 2017; 7(9), 69; doi: 10.3390/ani7090069. Epub 2017; Sept 2. 

Aleman M, Pickles KJ, Conley AJ, Stanley S, Haggett E, Toth B, Madigan JE. Abnormal plasma neurosteroid concentrations in ill, neonatal foals presented to the neonatal intensive care unit. Equine Vet J 2013;45(6):661-665.

Toth B, Aleman M, Brosnan RJ, Dickinson PJ, Conley AJ, Stanley SD, Nogradi N, Williams DC, Madigan JE. Evaluation of the squeeze induced somnolence in neonatal foals. Am J Vet Res 2012;73:1881-1889.

Madigan JE, Haggett EF, Pickles KJ, Conley A, Stanley SD, Moeller B, Toth B, Aleman M. Allopregnanolone infusion induced neurobehavioral alterations in a neonatal foal: Is this a clue to the pathogenesis of neonatal maladjustment syndrome? Equine Vet J 2012;44(41):S109-112.