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SEPSIS AND SEPTIC SHOCK IN THE EQUINE NEONATE CASE STUDY LATEST VERSION 2024|| ASSURED PASS!!
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SEPSIS AND SEPTIC SHOCK IN THE EQUINE NEONATE CASE STUDY LATEST VERSION 2024|| ASSURED PASS!!
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483 | P a g eSEPSIS AND SEPTIC SHOCK IN THE EQUINE NEONATE
CASE STUDY LATEST VERSION 2024|| ASSURED PASS!!
a, b
Christopher Langdon Fielding, DVM *, Kiragos Gary Magdesian, DVM
Antimicrobial ● Hemodynamic support ● Source control ● Blood culture
KEY POINTS
Equine neonatal sepsis is associated with an increased mortality rate compared with other
medical conditions affecting newborn foals.
As sepsis progresses to severe sepsis and septic shock, the prognosis becomes worse.
Recognition of sepsis in foals is poor given current laboratory and examination
parameters.
Early and aggressive treatment of presumed cases of neonatal sepsis is warranted.
INTRODUCTION
Sepsis and specifically the development of septic shock represent one of the most significant
causes of morbidity and mortality in equine neonates. Although under- standing of the
pathophysiology of sepsis continues to evolve, the condition remains challenging to manage
and failure is common despite considerable advancements intreatment. Early recognition of
sepsis is essential to successful management and re- quires a coordinated effort between stable
managers, field veterinarians, and neonatalintensive care unit clinicians.
This article reviews the recognition of sepsis/septic shock and current treatment
recommendations for this condition. The research available on equine neonatal sepsis(ENS) is
limited, but new information is available each year. This article brings togetherequine-specific
information and incorporates the most recent human Surviving Sepsis guidelines that were
published in 2012.1
Briefly, sepsis is defined in a patient in which the systemic inflammatory response syndrome
(SIRS) is caused by infection (Box 1). In human critical care, SIRS includesalterations in two
of the following parameters: body temperature, heart rate,
The authors have nothing to disclose or any conflicts of interest.
a Loomis Basin Equine Medical Center, 2973 Penryn Road, Penryn, CA 95663, USA; b Department
of Medicine and Epidemiology, School of Veterinary Medicine, University of Cal -ifornia, Davis, 2108
Tupper Hall, Davis, CA 95616, USA
* Corresponding author.
E-mail address: langdonfielding@yahoo.com
Vet Clin Equine 31 (2015) 483–496
http://dx.doi.org/10.1016/j.cveq.2015.09.001 vetequine.theclinics.com
0749-0739/15/$ – see front matter © 2015 Elsevier Inc. All rights reserved.
, Sepsis and Septic Shock in the Equine 484
Neonate
Box 1
Severe sepsis: Sepsis plus sepsis-induced organ dysfunction or tissue
hypoperfusion Septic shock: Sepsis-induced hypotension persisting despite
respiratory function, and peripheral white cell counts. This definition has been extrap-olated
for use in foals. Severe sepsis is a progression to the point that sepsis is asso-ciated with organ
dysfunction, hypotension, and/or hypoperfusion. Septic shock is defined as sepsis-induced
hypotension despite adequate fluid resuscitation, or vasopressor-dependent sepsis.
PATIENT EVALUATION
Early recognition of ENS is critical for early initiation of treatment, improvement in out-comes,
but also for determining a realistic prognosis. Neonates may present for inten-sive care for a
variety of conditions (eg, hypoxic ischemic encephalopathy, ruptured bladder) that may have a
better prognosis than sepsis. Given that the mortality rate for ENS is as high as 50%, its
recognition is important when discussing prognosis with owners.2 In general, suspicion of ENS
can be divided into three categories: (1) his-torical information, (2) physical examination, and
(3) laboratory markers.
Although the criteria for the diagnosis of sepsis do not often include historical infor-mation,
sepsis should be considered in patients that have specific historical events that serve as risk
factors (Box 2). Historical information that would increase the index of suspicion for ENS
include factors that existed before foaling, specific events that occurred during foaling, and
developments in the period following foaling.
Owners and veterinarians may observe abnormalities in the mare before foaling thatare cause
for concern. These include premature lactation, increased vaginal discharge, or early signs of
parturition. Although these findings are not uniquely asso-ciated with ENS, they warrant further
evaluation and more intensive fetal monitoring, such as fetoplacental ultrasound or fetal
electrocardiography. When evaluating an equine neonate, these prefoaling historical findings
may cause the clinician to initiatetreatment of ENS sooner than for a foal without these risk
factors.
Prolonged second stage of labor is an important finding during foaling that may in- crease
the risk for the development of ENS. Other concerning abnormalities might include an
abnormal appearance of the placenta or the amniotic/allantoic fluids. Similar to prefoaling
events, abnormal developments during foaling do not define
Box 2
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