Use of extracorporeal hemoperfusion in a 2-day-old foal with neonatal sepsis.

Use of extracorporeal hemoperfusion in a 2-day-old foal with neonatal sepsis demonstrated temporary clinical improvement and reduction of inflammatory markers, though complications arose and the foal was ultimately euthanized.

Objective and Case Description

• A 2-day-old Miniature Horse filly showed severe neonatal sepsis symptoms, failure of passive immunity transfer, and aspiration pneumonia.
• Initial treatment included broad-spectrum antibiotics, hemodynamic support, and administration of hyperimmune plasma.
• Due to lack of clinical improvement within 24 hours, advanced blood purification therapy — extracorporeal hemoperfusion (HP) — was initiated.

Hemoperfusion Treatment and Methodology

• The foal was treated with hemoperfusion using a polymer-based device called VetResQ.
• Hemoperfusion is an extracorporeal therapy designed to remove toxins, inflammatory mediators, and cytokines from the bloodstream.
• This approach was novel for neonatal septic foals, representing a new treatment avenue outside traditional antimicrobial and supportive care.

Observed Clinical Findings During and After Hemoperfusion

• Improved physical examination parameters were noted, suggesting a temporary clinical improvement.
• Increase in total white blood cell count, indicating a possible immunologic response or recovery.
• Reduction in cytokine and chemokine concentrations, demonstrating effective removal of inflammatory mediators by the hemoperfusion device.
• However, notable adverse effects were observed, such as progressive thrombocytopenia (low platelet count), which may have resulted from the sepsis itself or the hemoperfusion procedure.
• Increased hemolysis index, signifying some degree of red blood cell destruction.
• Development of hyperbilirubinemia, reflecting liver dysfunction or hemolysis consequences.

Outcomes and Limitations

• The hemoperfusion treatment was well tolerated by the foal without immediate procedural complications.
• Despite temporary improvements, the foal developed multiple septic polyarthritis sites, a serious complication of sepsis.
• Due to worsening condition and financial constraints, euthanasia was elected approximately 48 hours post-treatment.
• This report highlights that while polymer-based hemoperfusion can reduce inflammatory mediators and improve clinical parameters in neonatal septic foals, complications are possible and outcomes uncertain.
• Further studies would be required to establish efficacy, optimal protocols, and safety in this patient population.

Significance and Novelty

• This is the first documented use of polymer-based hemoperfusion in a septic neonatal foal.
• It introduces an extracorporeal blood purification technique as a potential adjunctive treatment in severe equine neonatal sepsis.
• While not curative in this case, the intervention may hold promise for addressing systemic inflammation and cytokine storm in similar patients.
• The case underscores the complexity of managing neonatal sepsis and the importance of addressing both infection and immune dysregulation.