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

Polymer-based hemoperfusion may transiently reduce cytokines in septic neonatal foals but requires further outcome study.

A 2-day-old Miniature Horse filly presented with neonatal sepsis, failure of passive transfer, and aspiration pneumonia. Initial management included broad-spectrum antimicrobials, hemodynamic support, and hyperimmune plasma transfusion. Due to failure to improve within 24 hours, extracorporeal hemoperfusion (HP) using a polymer-based cytokine adsorption device (VetResQ) was initiated — representing the first reported use of this technology in a septic neonatal foal. During and following the HP session, clinically notable improvements were observed including enhanced physical examination parameters, an increased total white blood cell count, and reduced circulating cytokine and chemokine concentrations, suggesting effective blood purification. However, the procedure was associated with progressive thrombocytopenia (attributed to either sepsis progression or the HP circuit), an increased hemolysis index, and hyperbilirubinemia. Overall, the treatment was reported to be well tolerated hemodynamically. Despite these short-term improvements, the foal developed multiple sites of septic polyarthritis approximately 48 hours post-procedure and was euthanized due to disease progression and financial constraints. This case highlights both the potential utility and the limitations of polymer-based hemoperfusion as an adjunctive therapy for neonatal equine sepsis, and underscores the need for further investigation into patient selection, timing of intervention, procedural risks, and long-term outcomes in this population.

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