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

A 2-day-old Miniature Horse filly presented with severe clinical and clinicopathologic findings consistent with neonatal sepsis, failure of transfer of passive immunity, and aspiration pneumonia. The filly initially was treated with broad spectrum antimicrobials, hemodynamic support, and hyperimmune plasma. Because of a lack of improvement within the first 24 h, extracorporeal blood purification and cytokine removal were implemented. The foal underwent hemoperfusion (HP) using a polymer-based device (VetResQ). Reported notable changes during and after treatment included improved physical examination variables, increased total white blood cell count, and decreased cytokine and chemokine concentrations. However, progressive thrombocytopenia (secondary to sepsis or HP), increased hemolysis index, and hyperbilirubinemia also were observed after the procedure. The treatment was well tolerated. Ultimately, the foal was euthanized approximately 48 h post-procedure because of development of multiple sites of septic polyarthritis and associated financial constraints. Polymer-based HP has not previously been used to treat septic neonatal foals.