Important milestones and common health issues in equine neonatesThe first 24 hours of a foals life bring crucial events and milestones that dictate his health and viability. | Courtesy Molly CzubAs prey animals that depend on flight for survival, horses enter the world genetically programmed to hit the ground running. Motility, alertness, and a good suckle reflex at birth make all the difference between a strong, healthy newborn foal and an at-risk neonate.The first 24 hours of a foals life bring crucial events and milestones that dictate his health and viability. Weve gathered the latest research and expertise from practitioners focused on equine neonatology to help you know what to expect, when to intervene, and how to involve your veterinarian throughout the first day of your new foals life.ParturitionThe Birthing ProcessThe milestone: A foals first day marks the shift from in utero to extrauterine life.Potential problems: Parturition-related issues can include dystocia (difficult birth), due to malpositioning or unusually large fetuses, or uterine inertia (lack of contractions). If blood flow is compromisedwhether from prolonged labor, premature placental separation (red bag delivery), umbilical cord compression, or placental insufficiencythe foal may experience hypoxia (lack of oxygen to the brain), which can cause permanent damage to the intestinal tract and other organs, says Karen Wolfsdorf, DVM, Dipl. ACT, a theriogenologist at Hagyard Equine Medical Institute, in Lexington, Kentucky.The veterinarian is not usually in attendance for a normal birth, says Miranda Gosselin, DVM, of Millbrook Equine Veterinary Clinic, in New York. Unless your mare is foaling in a hospital, your veterinarian will only come out if there is a problem, and that would constitute an emergency. If your foal is born at home overnight, do call your vet in the morning to schedule the neonatal exam and post-foaling mare exam.Standing and NursingThe milestone: Standing within one hour and nursing within two hours after birth. Potential problems: If the foal is unwilling or unable to get up, this may be due to fractured ribs from trauma during foaling, Wolfsdorf explains. Serious systemic health issues can also impact a foals viability and mobilitynotably neonatal sepsis. This life-threatening infection most commonly originates in utero, rather than after birth. Clinical signs include fever, lethargy, swollen joints, and decreased nursing.Another condition in this population, neonatal maladjustment syndrome (often called dummy foal syndrome), can impair a neonates ability to stand and nurse. Oxygen deprivation during birth triggers the condition and affected foals appear uncoordinated or unresponsive. A healthy foal will find the mammary gland and not wander around aimlessly sucking the wall, Wolfsdorf says.Neonatal maladjustment syndrome arises from multiple contributing factors and can be compounded by sepsis.Limb Alignment and Tendon LaxityThe milestone: Standing unassisted on four sturdy, stable limbs.Potential problems: Mild limb deviations or tendon laxity commonly occur in newborns, particularly in larger foals and after long gestational periods.1 Usually these self-correct.2 However, severe conformation deviations, inability to stand squarely, or knuckling over at the knees raise a red flag. Contracture correction can require a spectrum of therapies, including splinting and administration of the antibiotic oxytetracycline, says Gosselin. Limb deviations can be nuanced, involving (toe) extensions and exercise restriction. If you have any concerns about the foals conformation, wait for the veterinarians examination and approval before turning the mare and foal outside.Immunity Through ColostrumThe milestone: Developing immunity. Unlike humans and many other mammals, foals dont receive immune protection during pregnancy. Mares multilayered placentas, classified as diffuse epitheliochorial, prevent direct antibody transfer between dam and offspring.3Potential problems: A foal essentially has no immune system at birth and must acquire passive immunity by ingesting his dams colostrum. This thick, nutrient-rich first milk contains crucial antibodies from the mares own vaccinations and previous exposure to pathogens. Thats why veterinarians recommend timely, strategic vaccination of broodmares throughout pregnancy to protect foal health and safety.Failure of passive transfer (FPT) occurs if a foal doesnt acquire enough immunity within his first day of life, and serum (blood) immunoglobulin G (IgG) levels stall below 800 milligrams/deciliter.4 A quick and reliable toolthe immunocrit methodhas proven effective for early screening directly on the farm, without the need for laboratory processing.5 You can also use a refractometer, colostrometer, or brixometer (Brix refractometer) to measure the quality of colostrum IgG, Wolfsdorf adds.If a foal fails to nurse within the first two hours, or the mares colostrum appears watery or scant, you must act quickly. The foal experiences gut closure (inability to absorb antibodies) by 18 to 24 hours postpartum, says Wolfsdorf. Therefore, it is important to determine IgG levels early, preferably between six to 12 hours post first suckle. If IgG is low in the first 18 hours, find a good, tested colostrum from a colostrum bank and administer colotrum to the foal via nasogastric tube. Wolfsdorf describes a good source of colostrum as one that contains high levels of imunoglobulin and no alloantibodies that could cause neonatal isoerythrolysis (NI), an immune condition in which antibodies in colostrum destroy the newborn foals red blood cells.If oral colostrum administration is not an option, or if the 18-hour window has closed, then intravenous (IV) administration of high immunoglobulin plasma is necessary, she says. If IgG is low, the neonate is at increased risk for infection and sepsis, so preventative antibiotics may also be needed. The earlier the intervention, the better the prognosis, she adds.Umbilicus Care and Patent UrachusThe milestone: closure of the urachus, the tube that connects the foals bladder to the placenta in utero.Potential problems: After the umbilical cord breaks naturally during parturition, the umbilical stump should be dipped two to three times daily for the first couple of days until it dries out. Gosselin likes to use a 0.5% solution of chlorhexidine (three parts water to one part 2% chlorhexidine). For those who prefer povidone-iodine (Betadine), she recommends using one part Betadine to 20 parts water.Make sure you are refreshing your naval dip regularly so that you dont introduce debris or bacteria, she says. Evaluation of the umbilicus is a very important part of the new foal exam, and it should continue to be monitored closely for the first four to six weeks of life. I always do a thorough navel inspection as part of my foal exam.Occasionally, the urachus fails to close. A patent urachus results in urine leaking from the stump, a red flag signaling the need for prompt veterinary care to prevent an ascending infection.6 Luckily, I dont see many patent urachi, Gosselin says. When I do, its typically a foal that has been sick. Any foal with a patent urachus should be on antibiotics and should be monitored via ultrasound.Researchers on published case studies report a higher incidence of patent urachus in male foals.First Output: Meconium, UrinationThe milestone: By three hours post-birth, foals should pass meconium, the dark, tarlike first feces. Urination typically occurs within eight to 10 hours.Potential problems: Delayed urination, especially in colts, might suggest a ruptured bladder, which can occur with dystocias and require emergency surgery.7 Meconium impaction, typically occurring within six to 12 hours after birth, presents with coliclike symptoms, straining to defecate, and tail flagging. Typically, a warm, soapy enema administered rectally by a veterinarian or experienced breeding farm manager resolves it quickly.If the foal does not want to defecate, it could be because its painful, Wolfsdorf says. If he strains to urinate or defecate, this can be a sign of a problem, and consultation with a veterinarian is necessary.Normal vs. Abnormal Parameters in Neonates and Possible Associated Health IssuesHEALTHY FOALVETERINARY ATTENTION REQUIREDPOSSIBLE ISSUEStands within one hourStill recumbent after two-plus hoursNeonatal maladjustment syndrome, tendon laxity, limb deformity, birth injury, broken ribs, sepsisNurses stronglyWeak suckle reflex or struggles to find udderNeonatal maladjustment syndrome, could lead to failure of passive transfer.Alert and bonded to damWandering, confused, dull, or disoriented behaviorNeonatal maladjustment syndromeSteady breathing (30-40 bpm)Labored or noisy breathingBirth injury, fractured ribsNormal temperature (99.5-102 F)Fever (>103 F) or cold extremitiesNeonatal sepsis, infectionDry, clean umbilicusMoist, dripping, or swollen navel at 24+ hoursPatent urachusA Note On the MareAlthough this discussion focuses on the newborn foal, the dams health in the hours after foaling remains clinically important. Failure to pass the placenta within three hours can lead to rapid onset of sepsis, fever, and, in some cases, laminitis (painful inflammation of the tissue suspending the coffin bone within the foot), which can eliminate her as an effective caretaker for her foal.Take-Home MessageCompared to humans, horses develop and mature very rapidly at birth. Their very survival in the wild depends on their ability to nurse on their own, recognize and follow their dam, and be coordinated and quick enough to flee from predatorsall within the first few hours of their lives. Knowing the milestones of the first 24 hours and recognizing when a foal misses them helps horse owners and breeding managers respond quickly. For those helping welcome foals into the world, informed observation, prompt recognition of warning signs, and timely veterinary intervention can mean the difference between a healthy start and life-threatening complications.References1. Mouncey R, Arango-Sabogal JC, de Mestre AM, Verheyen K. Gestation length is associated with early-life limb deformities in Thoroughbred foals. J Equine Vet Sci. 2023;129:104896.2. Kotoyori Y, Endo Y, Murase H, Sato F, Korosue K. Changes in aspects of hoof and distal limb conformation in foals by radiographic evaluation. J Vet Med Sci. 2024;86(4):421427.3. Borghesi J, Mario LC, Rodrigues MN, Favaron PO, Miglino MA. Immunoglobulin transport during gestation in domestic animals and humans: A review. Open J Anim Sci. 2014;4(5):323336.4. Oberkersch LE, Schuberth H, Weber C, Freise F, Venner M. Kinetik of the IgG concentration in the blood of neonatal foalscomparison of foals with focal infectious diseases with healthy foals. PferdeheilkundeEquine Medicine. 2022;38(3):134141.5. Mortola E, Miceli G, Alarcn L, Azcurra M, Larsen A. Assessment of the immunocrit method to detect failure of passive immunity in newborn foals. Equine Vet J. 2020;52(5):760764.6. Bernick A, Krohn J, Wehrend A. Patent urachus and associated comorbidities in 101 newborn foals: A retrospective study. Vet Med Sci. 2025;11(3):e70379.7. Bernick A, Nieth J, Wehrend A. Uroperitoneum in the foal: A review of the literature. Veterinary Practice. 2021;49(1):4150.This article is from the Spring 2026 issue ofThe Horse: Your Guide to Equine Health Care. We at The Horse work to provide you with the latest and most reliable news and information on equine health, care, management, and welfare through our magazine and TheHorse.com. Your subscription helps The Horse continue to offer this vital resource to horse owners of all breeds, disciplines, and experience levels. To access current issues included in your subscription, please sign in to theAppleorGoogleapps ORclick herefor the desktop version.