How the Madigan squeeze can save a dummy foal's life

For foals who fail to wake fully at birth, an innovative veterinary technique could be the answer. Kelly Harrison-Tait MRCVS explains

The majority of foals born are fit, healthy and ready for the world, but sometimes things aren’t quite right. One condition that can affect a newborn foal is neonatal maladjustment syndrome, also known as being a “dummy foal”. A procedure that can help in this situation is the Madigan squeeze.

Traditionally, oxygen deprivation to the brain is thought to be the reason for this neonatal maladjustment syndrome, resulting in brain damage and inadequate blood supply to the nerve cells. Oxygen deprivation can result from the placenta coming away abruptly from the uterus before foaling, prolonged labour, prematurity, sepsis and swelling of the brain, among other causes.

Another, newer consideration is failure of the foal’s mental state to evolve from somnolence within the uterus to consciousness at birth, which normally occurs as the foal travels through the birth canal. The squeezing effect of the canal halts the release of neurosteroids. These keep the foal in a state of unconsciousness in the uterus; if no signal is received to stop their production they continue to be emitted, preventing the foal from becoming fully conscious as he emerges.

Slow to respond

A dummy foal will often be slow to follow the expected patterns of behaviour, not standing or drinking within the normal time-frame, for example. He may be lethargic and “forget” to lie down or stand up, needing assistance or reminding.

The foal is typically unable to interact fully both with his dam and his environment. When going to feed, he may struggle to locate the udder or fully latch on – this can lead to failure of passive transfer, a process where the foal receives essential antibodies from the mare. If he does not ingest enough colostrum before his gastrointestinal tract stops being able to absorb these large proteins, he is at increased risk of sepsis and other life-threatening illnesses.

Failure to spot the signs and initiate treatment can mean that a dummy foal develops a dangerously low body temperature (hypothermia) or blood sugar levels (hypoglycaemia), which can ultimately lead to death.

Foals are born with very little energy storage in the form of fat, so intervention to ensure that the affected foal receives adequate colostrum can be essential. Care must always be taken if bottle-feeding a foal, because aspiration pneumonia can result if any fluid, such as milk, enters the lungs. Due to their often poor suck reflex, dummy foals need to be fed with extra caution.

It is important to seek veterinary advice, as stomach-tubing the colostrum is often considered safer. An intravenous drip may also be necessary, containing warm fluids, glucose and other neuro-protective agents such as thiamine and vitamin C.

Most foals recover well within one to five days, with correct care and if closely monitored, and begin to behave as expected.

The Madigan squeeze

The Madigan squeeze is a procedure that can be used on a foal displaying dummy signs in an effort to recreate the natural transition to consciousness.

A rope is secured around the foal by looping it around the chest several times. Tension is then applied to mimic the pressures implemented by the birth canal during the foal’s journey from the uterus to the outside world, and at the same time the foal is helped to lie down.

The rope is held for 20 minutes, the duration that the mare would be in second-stage labour. During this time, the foal becomes somnolent and lies asleep within the rope.

At the point the rope is released, the foal awakens, and, if the procedure has been successful, displays normal consciousness –usually going straight to the dam to drink. With these foals who have responded well to the technique, the prognosis is excellent as the sedative effect from the neurosteroids has been switched off.

The Madigan squeeze will not work on those who have suffered from hypoxic injury to the brain, unfortunately, although attempting the method will do no harm. The only caveat is that the foal is first checked carefully for evidence of rib fractures; if injury is detected, it is not safe to squeeze the foal.

“He was so floppy”

Miniature Shetland colt Gizmo weighed just 9.5kg when he was born on a snowy night in the Scottish Borders in late March. While the mare, Fern, appeared to foal without issue, owner Charlotte Mills soon sensed that something was wrong.

“Although Gizmo seemed physically perfect, he was so floppy that he couldn’t stand,” she recalls. “He was unresponsive and was getting cold, so we took him indoors and put him in front of the fire.”

Gizmo was referred by Charlotte’s local veterinary practice to the Dick Vet Equine Hospital, where he arrived early the next morning after a short lorry journey spent sitting on Charlotte’s lap. Now nearly 12 hours old, he had yet to stand or nurse from his dam.

“Examination revealed that Gizmo was hypothermic, with a poor suckle reflex, a drowsy demeanour and physical evidence of immaturity,” says Rachel Jago MRCVS, who confirms that the tiny foal was diagnosed with neonatal maladjustment syndrome.

“He was admitted to the foaling intensive care unit, under the care of the specialist medical team, and wrapped in a Bair Hugger warming blanket to maintain his core temperature.

“He was fed the dam’s colostrum every two hours, via a nasogastric tube, together with intravenous fluids and antimicrobial therapy,” adds Rachel. “The Madigan foal squeeze technique was performed and his demeanour improved.”

After 36 hours of round-the-clock care, Gizmo was up on his feet and able to suckle unassisted. Three days later, he and Fern could return home.

“Gizmo is still small, even for a mini Shetland, but he’s lovely,” says Charlotte, whose husband Douglas bred him. “He’s happy and healthy, like a little bison.”

Glazed and lifeless

“It was as if the lights were on but no-one was home,” says international showjumper Jay Halim of the glazed, lifeless look his warmblood colt foal Herbie (pictured top) developed during his first 12 hours. “He had arrived a little earlier than expected, but he had seemed bright and normal at first and was suckling well. As the day progressed, he went downhill.”

While Herbie would go to the udder, he wouldn’t drink. Jay had tried milking the mare and offering the foal a bottle, but Aled Thomas MRCVS, a stud vet at Bourton Vale Equine Clinic, recognised dummy foal syndrome and advised that Herbie should be transferred to the clinic.

“Herbie was initially managed with an indwelling stomach tube, so that we could feed him the mare’s milk and ensure that his hydration and energy levels were maintained,” explains Aled. “We later performed the Madigan foal squeeze technique, which was so successful that he was able to suckle almost immediately.”

Eight months later, Herbie has been paired up for turnout with another uncastrated colt.

“You wouldn’t know he’d ever had a problem,” says Jay. “He’s a cheeky monkey, but everyone loves Herbie.”

Ref: Horse & Hound; 24 December 2020

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