Pathophysiology Diagnosis and Treatment of Neonatal Maladjustment Syndrome (NMS) in Foals

Presentation Description / Summary: Neonatal maladjustment syndrome (NMS) is a condition used to describe foals that develop neurologic signs of non-infectious nature in the immediate postpartum period. NMS continues to be a major reason for hospitalization and cause of death in neonatal foals. While some progress in understanding the pathogenesis of NMS has been made, the exact mechanisms of neuronal damage or dysfunction are still unknown. NMS encompasses a range of signs related to neurological dysfunction, from disorientation and nursing problems to coma and seizures in the post-partum period. Currently, NMS is diagnosed through clinical examination and exclusion of other potential causes of neurological signs. Proposed mechanisms for NMS include maladaptation to life outside the uterus, abnormal endocrine responses (high concentration of neurosteroids), perinatal asphyxia and hypoxia, and metabolic imbalances. Research has shown consistently high concentrations of steroids with neuroactive properties (progestogens, androgens) in foals with NMS and other neonatal diseases, suggesting a role for altered neurosteroid metabolism in consciousness and preparation for extrauterine life. However, there are major knowledge gaps in the mechanisms underlying this clinical disorder and potential treatments. It was recently proposed that other markers of brain injury, such as brain-derived neurotrophic factor (BDNF) or glial-fibrillary-acidic protein (GFAP) might be used in monitoring foals with NMS. This lecture will provide an in-depth current review of NMS pathophysiology in foals. Diagnostic and treatment options and any possible adverse effects of treatments will also be discussed. The audience will be invited to participate by online voting and contributing their own experiences.

Learner Outcomes: 1. Enhance our understanding of the pathophysiology of NMS, including differential diagnoses 2. Discuss the importance of monitoring neurosteroids and neuropeptides as markers of brain dysfunction and injury 3. Describe current diagnostic and therapeutic approaches for NMS in neonatal foals