Does discarding the first few millilitres of breast milk improve the bacteriological quality of bank breast milk?

Carroll, L.; Osman, Mohamed; Davies, David

doi:10.1136/adc.55.11.898

Cited by 16 publications

(7 citation statements)

References 3 publications

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“…Gram-negative bacteria were present in 21 milk sample from 51 (53%) of 96 women providing milk. Of women with at least one milk sample containing gram-negative bacteria, 16 (31%) had only a single species recorded, 15 (29%) had two species, 7 (14%) had three species, 6 (12%) had four species, 4 (8%) had five species, 2 (4%) had six species, and 1 had nine unique species recovered. There was no discernible temporal pattern for gram-negative content in milk from any donors.…”

Section: Study Population Characteristics Expressed Breast Milkmentioning

confidence: 99%

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Is ingestion of milk-associated bacteria by premature infants fed raw human milk controlled by routine bacteriologic screening?

et al. 1989

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Expressed human milk is often used to feed premature infants. Raw milk contains bacteria which may be a source of infection. Milk banks have developed screening programs which combine periodic quantitative milk cultures with arbitrary rules specifying limits of bacterial concentration. It is unknown whether such programs succeed in preventing infants from being fed milk containing bacteria. At the Health Sciences Centre (Winnipeg, Manitoba, Canada), milk is screened once weekly. When a woman's milk is found to have excess bacteria, it is discarded only if she is an unrelated donor (as opposed to an infant's mother). To assess the effectiveness of this screening program, we determined the frequency at which infants fed raw human milk were exposed to milk-associated bacteria and compared the bacterial contents of donor and maternal milk. From February 1986 to April 1987, all human milk fed to 98 premature infants during the first 2 weeks of feeding (n = 10,128 feeds) was cultured quantitatively. Among study infants, 100% were exposed at least once to coagulase-negative staphylococci, 41% were exposed to Staphylococcus aureus, and 64% were exposed to gram-negative bacilli. The proportions of feeds containing bacteria and the quantities (log10 CFU [mean +/- standard deviation]) ingested per positive feed were: 39% and 5.9 +/- 0.5 for coagulase-negative staphylococci; 2.4% and 5.1 +/- 1.0 for S. aureus; and 5.2% and 4.8 +/- 1.1 for gram-negative bacilli. There were no adverse events attributable to ingestion of milk-associated bacteria. Milk coagulase-negative staphylococcal isolates were multiply antibiotic susceptible, whereas infant isolates were antibiotic resistant. Donor milk was significantly less likely than maternal milk to contain coagulase-negative staphylococcal species in any quantity (40 versus 93% of samples, respectively [P < 0.001]) or in concentrations exceeding 10(8) CFU/liter (3 versus 27% of samples, respectively [P < 0.0001]). There was no difference between milk from either source in terms of S. aureus or gram-negative bacterial content (4 to 6%). These results suggest that the Health Sciences Centre screening program is effective in limiting the number of harmless coagulase-negative staphylococcal species but has no impact on the quantity of potentially pathogenic bacteria ingested by premature infants. Implications for screening donor milk are discussed.

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Section: Study Population Characteristics Expressed Breast Milkmentioning

confidence: 99%

“…Human milk usually contains coagulase-negative staphylococci, alpha-hemolytic streptococci, and diphtheroids, all representing normal skin flora (5,9,28). Gram-negative bacilli have been found in milk from 5 to 15% of women (4)(5)(6)(7)9). Safe limits for bacterial concentration in human milk used to feed premature infants have never been established.…”

mentioning

confidence: 99%

Is ingestion of milk-associated bacteria by premature infants fed raw human milk controlled by routine bacteriologic screening?

et al. 1989

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“…The comparability of the four breast milk samples may be questioned because there are studies suggesting an increased bacterial load of the first milliliters of milk, 38 which was not observed in other studies. 39,40 In our study, the spectrum of bacteria is slightly wider in the collecting bottle and milk bank samples than in the manually expressed ones. It is therefore unlikely that highly concentrated bacteria in the first samples are only diluted in the collecting bottle.…”

Section: Discussionmentioning

confidence: 56%

Bacterial Contamination of Mechanically Extracted Breast Milk

et al. 2013

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“…This observation has been previously reported 2 but not by all investigators. 1 Perhaps it should be noted that these data do not address the issue of bacterial growth (CFU/ml) over time based on collection method or container type. Previous work has documented limited bacterial growth in human milk for 6 hours postexpression collected in sterile containers and stored at room temperature.…”

Section: Discussionmentioning

confidence: 99%

Bacterial Contamination of Human Milk: Container Type and Method of Expression

Pittard¹,

Geddes²,

Brown³

et al. 1991

Amer J Perinatol

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Common questions from nursing women include: is the bacterial contamination of expressed milk different if collected manually versus mechanically and is there a large increase in bacterial contamination if the milk is collected into clean versus sterile containers. Similarly, there are mixed reports, and secondarily confusion, among lactating women regarding the benefit of discarding the initial portion of a milk expression to limit bacterial contamination with skin flora. To answer these concerns, we have measured the number of colony-forming units (CFU)/milliliter in expressed milk from 16 women. The experimental design, used in a randomized fashion with each woman, employed both sterile and clean containers for collection and both the manual and mechanical techniques for milk expression. The number of milk specimens containing greater than 10(4) CFU/ml was not different between those collected in clean versus sterile containers or between those collected with a manual versus a mechanical technique. Finally, the initial milk expressed did not have a significantly greater amount of bacterial contamination than the milk collected later in the milk expression.

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Does discarding the first few millilitres of breast milk improve the bacteriological quality of bank breast milk?

Cited by 16 publications

References 3 publications

Is ingestion of milk-associated bacteria by premature infants fed raw human milk controlled by routine bacteriologic screening?

Is ingestion of milk-associated bacteria by premature infants fed raw human milk controlled by routine bacteriologic screening?

Bacterial Contamination of Mechanically Extracted Breast Milk

Bacterial Contamination of Human Milk: Container Type and Method of Expression

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