The first few hours after birth are critical for every foal. While most are on their feet and nursing within a short time, others fail to recognise their dam, cannot suckle properly or develop alarming neurological signs. Distinguishing neonatal maladjustment syndrome (NMS) from other serious conditions can be challenging, but new research suggests that naturally occurring proteins in the blood may provide veterinarians with valuable clues.
A study recently published in the Journal of Veterinary Internal Medicine found that several neuroproteins and neurosteroids differ between healthy foals and those affected by NMS, raising the possibility of more accurate diagnosis and improved monitoring of this complex neurological disorder, sometimes known as "dummy foal syndrome."
Neonatal maladjustment syndrome is a complex condition that usually develops at birth or within the first two days of life. Although the exact cause remains uncertain, many affected foals recover if serious brain injury during foaling can be ruled out and they receive appropriate supportive care.
Clinical signs vary widely. The most common problem is failure to develop a normal suckling reflex, making it difficult for foals to nurse. More severely affected foals may become disorientated, develop seizures or even lapse into a coma. Treatment is largely supportive, often involving tube feeding or teaching the foal to drink from a bucket until it is able to nurse normally, together with intensive veterinary care where needed.
Researchers from North Carolina State University investigated whether naturally occurring substances associated with the brain could provide useful biological markers of the disease. They focused on three neuroproteins: brain-derived neurotrophic factor (BDNF), glial fibrillary acidic protein (GFAP) and S100B, a protein produced mainly by astrocytes, specialised cells that support nerve cells within the brain.
These biomarkers are already used in human medicine to investigate neurological disorders, including neonatal brain injury, but their potential role in equine medicine has received little attention.
The study followed 72 foals less than seven days old. Fourteen were healthy, 19 had NMS and 39 were hospitalised with other conditions, including sepsis, diarrhoea and prematurity. Blood samples were collected on admission and again after one and two days in hospital. Of the 58 hospitalised foals, 48 survived.
The researchers also measured concentrations of progesterone-derived neurosteroids, known as pregnanes. These compounds are present at high concentrations in healthy newborn foals immediately after birth but normally fall rapidly within the first 24 to 48 hours. Previous studies have suggested that foals with NMS continue to have elevated concentrations for much longer.
That pattern was confirmed. Pregnane concentrations remained significantly higher in foals with NMS than in both healthy foals and those hospitalised for other illnesses throughout the first 48 hours.
The research team also found important differences in the neuroproteins. Blood concentrations of BDNF fell during the first day of hospitalisation in foals with NMS. S100B concentrations were particularly high in septic foals that also had NMS, compared with septic foals without neurological disease. GFAP concentrations were lower in both NMS foals and other sick foals than in healthy newborns, suggesting it may be less useful as a specific marker for the condition.
Lead researcher Dr Katarzyna Dembek believes the findings are encouraging. She suggests that BDNF, S100B and pregnanes could become valuable biomarkers not only for neonatal maladjustment syndrome, but also for identifying neurological involvement in premature foals and those with sepsis.
However, the authors caution that the work represents an early step rather than a new diagnostic test. The study involved relatively small numbers of foals, and further research will be needed to establish normal reference ranges, determine how these biomarkers change during recovery and evaluate how reliably they can distinguish NMS from other neurological disorders in clinical practice.
If confirmed in larger studies, measuring neuroproteins alongside neurosteroids could provide veterinarians with a more objective way of assessing newborn foals with suspected neurological disease, allowing earlier diagnosis and potentially improving treatment decisions during the critical first days of life.
For more details, see:
Javier Perez Quesada, Kinnidy Coley, David Wong, Nimet Browne, Myriah Albrecht, Katarzyna Dembek,
Biomarkers of brain injury in foals with neonatal maladjustment syndrome,
Journal of Veterinary Internal Medicine, (2026) Vol 40, (5) aalag228
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