Saving the Somnolent Foal

A commonsense approach to nursing ‘dummy foals’ back to health

Dummy, barker, wanderer, sleeper. Neonatal encephalopathy. Hypoxic ischemic encephalopathy. Perinatal asphyxia. Neonatal maladjustment syndrome. No matter what you call the foal or the condition, it amounts to one sure thing: W-O-R-K.

“Affected foals can require intensive care if they are to be saved,” says Jen Gold, DVM, Dipl. ACVIM-LAIM, ACVECC, clinical associate professor at Washington State University, in Pullman. “This means round-the-clock care to keep them clean, dry, nourished, hydrated but not overhydrated, seizure-free, injury-free, avoid pressure sores if they are recumbent (lying down and unable to get up), and to frequently administer a medley of medications.”

In other words, caring for a critically ill foal will consume your time until the foal (hopefully) recovers. 

What Is a Dummy Foal?

Foals with neonatal maladjustment syndrome (NMS, also called maladjusted foals) suffer from an ill-defined noninfectious central nervous system dysfunction, explains Sally DeNotta, DVM, PhD, Dipl. ACVIM, clinical assistant professor of large animal medicine at the University of Florida, in Gainesville. Common signs of NMS include:

• Loss of affinity for the mare and aimless wandering;
• Excessive sleepiness and/or general dullness;
• Lack of suckle reflex;
• Stargazing, tongue protrusion, and stuporous behavior;
• Seizures, either mild focal events and facial spasms or generalized muscle convulsions;
• Apparent blindness;
• Abnormal vocalization that sounds like barking; and
• Irregular respiratory patterns.

Affected neonates (approximately 1-2% of live foals) usually exhibit the above-described clinical signs at or within a few days after an uneventful birth. Once a foal shows signs of neurologic abnormalities, your veterinarian should examine him and quickly rule out neurologic and other diseases affecting newborn foals, such as:

• Bacterial meningitis (central nervous system infection);
• Severe sepsis (systemic bacterial ­infection);
• Equine herpesvirus-1 ­myeloencephalopathy;
• Hepatoencephalopathy (abnormal liver function causing neurologic signs);
• Metabolic and electrolyte disturbances;
• Physical trauma (from a dystocia—a more difficult birth—or if the mare steps on the foal);
• Congenital disorders (conditions they’re born with—hydrocephalus, for example, which is excess fluid around the brain);
• Lavender foal syndrome, a genetic condition of Arabians; and
• White muscle disease (resulting from inadequate consumption of selenium or vitamin E).

Once your veterinarian lands on an NMS diagnosis, treatment must be swift. You must also decide whether to refer your mare and foal to a clinic or take on the momentous task of caring for the foal on the farm.

“Supportive care is the most important part of managing dummy foals, especially because many of these foals may be septic, as well,” says Gold. “Early referral is always better than waiting. Signs that you need to refer include an inability or unwillingness to nurse, abnormal behavior, and obtundation (lethargy or lack of alertness).”

Yes, 24-hour intensive care is expensive; however, with correct supportive care, approximately 70-80% of affected foals recover completely and can go on to lead normal adult lives.