EQUUS - - Eq Medical Front -

The first large-scale study of the phys­i­cal com­pres­sion pro­ce­dure known as the “Madi­gan squeeze tech­nique” con­firms that it helps new­born foals with neona­tal mal­ad­just­ment syn­drome (NMS) re­cover more quickly than those treated with only med­i­ca­tion. The tech­nique, which in­volves wrap­ping a foal’s up­per torso with loops of soft rope and ap­ply­ing pres­sure for 20 min­utes, repli­cates the com­pres­sion a foal ex­pe­ri­ences dur­ing birth.

NMS af­fects 1 to 3 per­cent of foals, most of whom re­quire ex­ten­sive and of­ten ex­pen­sive care. John Madi­gan, DVM, of the Univer­sity of Cal­i­for­nia—Davis de­vel­oped the squeeze tech­nique af­ter years of re­search into how NMS de­vel­ops. In an ear­lier study in­ves­ti­gat­ing the mech­a­nism of the “flop­ping re­ac­tion” in new­born foals, Madi­gan’s group found that pres­sure across the chest area pro­duced sig­nif­i­cant brain changes, in­duc­tion of slow wave sleep and hor­mone changes. He rea­soned that this is a bi­o­log­i­cal method that evolved to keep the foal im­mo­bi­lized as it passed through the birth canal. At the same time Madi­gan won­dered if the squeeze sig­naled the tran­si­tion from be­ing asleep in the womb to neu­roac­ti­va­tion and on­set of con­scious­ness---in other words, switch­ing the brain from neu­roin­hi­bi­tion to neu­roac­ti­va­tion, with the foal “wak­ing up” within a few hours to stand and nurse. Sur­vival of the foal as a prey an­i­mal would de­pend on this sig­nal­ing sys­tem, he sur­mised.

In cases of NMS, how­ever, the fac­tors in­volved in neu­roin­hi­bi­tion, which are largely seda­tive pro­ges­terone-de­riv­a­tive anes­thetic-like com­pounds, per­sist, and the foals do not make the tran­si­tion to con­scious­ness at birth. Foals with NMS re­main in­co­or­di­nated, un­able to nurse and wan­der around their stalls in an ap­par­ent stu­por for hours or even days af­ter birth. It’s as if the foals missed the sig­nal­ing to make the tran­si­tion from un­con­scious­ness in the womb to full wake­ful­ness. Madi­gan’s team found that foals with NMS have high lev­els of the seda­tive neu­ros­teroid com­pounds in their blood­streams.

Shortly af­ter pre­sent­ing these ini­tial find­ings at pro­fes­sional meet­ings and in vet­eri­nary jour­nals, Madi­gan’s re­search group re­quested in­for­ma­tion via a sur­vey sent to vet­eri­nar­i­ans, vet­eri­nary tech­ni­cians and farm man­agers around the world treat­ing foals with NMS.

Par­tic­i­pants were pro­vided with in­struc­tions on how to per­form the squeeze and asked to com­plete sur­veys doc­u­ment­ing their ex­pe­ri­ences us­ing it with NMS foals dur­ing 2015 and the first few months of 2016. Par­tic­i­pants re­ported whether they had tried the squeeze tech­nique and how quickly the foals re­cov­ered. For foals who did not un­dergo the squeeze pro­ce­dure, par­tic­i­pants de­scribed the med­i­cal treat­ments uti­lized and how quickly the foals re­sponded.

Over­all, in­for­ma­tion was col­lected on 195 foals who ex­hib­ited ab­nor­mal be­hav­ior im­me­di­ately af­ter birth. Of these foals, 87 un­der­went the com­pres­sion pro­ce­dure and 108 did not. All foals in the lat­ter group re­ceived some type of med­i­cal treat­ment, such as tube feed­ings, in­tra­venous flu­ids or

plasma ad­min­is­tra­tion. Only about half of the foals re­ceiv­ing squeeze treat­ment were given some type of med­i­cal ther­apy prior to the pro­ce­dure and an­other 20 per­cent re­ceived treat­ment af­ter­ward.

While the re­cov­ery rates were roughly the same--about 80 per­cent---whether foals re­ceived the squeeze tech­nique or not, the data showed squeezed foals re­cov­ered much faster than did foals re­ceiv­ing only med­i­cal treat­ment. Specif­i­cally, squeezed foals were 15 times more likely to re­cover in less than an hour than were the other foals. What’s more, foals re­ceiv­ing only the squeeze treat­ment, with no med­i­cal in­ter­ven­tion, were 17.5 times more likely to re­cover within the first 24 hours than were foals treated only with med­i­ca­tion.

By ac­cel­er­at­ing re­cov­ery, the squeeze tech­nique re­duces the need for pro­longed, stress­ful and ex­pen­sive med­i­cal care for NMS foals, the re­searchers note. “Fur­ther,” they say, “the op­tion of eu­thana­sia due to fi­nan­cial con­straints, lack of per­son­nel or re­sources to pro­vide ad­e­quate nurs­ing and in­ten­sive care, and/or per­cep­tion of poor prog­no­sis due to sever­ity of signs, can po­ten­tially be avoided.”

Ref­er­ence: “Sur­vey of vet­eri­nar­i­ans us­ing a novel phys­i­cal com­pres­sion squeeze pro­ce­dure in the man­age­ment of neona­tal mal­ad­just­ment syn­drome in foals,” An­i­mals, Septem­ber 2017

GOOD ODDS: Re­gard­less of treat­ment, roughly 80 per­cent of foals with neona­tal mal­ad­just­ment syn­drome re­cover.

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