For those of us old enough to remember, one of the reasons for the demise of
human milk feeding (and human milk banks) in the NICU's in the late 70's and
early 80's was the rash of epidemics of gram neg rod sepsis and NEC in NICUs,
where one mother would provide milk for most of the infants.  There were
multiple reports - most of which are too old for Medline, and long ago weeded
out of my filing system as "common knowledge".  Why do you think the old
neonatologists are hesitant to use human milk?  It is not just the
nutritional aspects, it is the infection control risk.

We now know that the best use of human milk is one mother's milk for her own
baby.  We do have a responsibility, however, to assure that since that milk
is not being fed directly from the breast, that both mothers and staff know
how to protect that liquid gold from contamination.  Luckily human milk is
resilient and filled with a redundancy of infection-fighting factors, so it
is rare there is enough contamination to be of clinical consequence.  But it
has, and does happen.

Those of you who have read Lactnet over the years know what an avid proponent
of human milk and breastfeeding I am, especially for preterm and ill infants.
 We will lose all credibility however, if we stick our heads in the sand when
bad things happen.

A few references I did find:
Ryder RW et al. Human milk contaminated with Salmonella kottbus. A cause of
nosocomial illness in infants. JAMA 1977; 238(14):1533-4

Stiver HG et al. Nosocomial colonization and infection due to E. coli
0125:K70 epidemiologically linked to expressed breast-milk feedings. Can J
Public Health 1977;68(6):479-82

Nosocomial salmonellosis in infants associated with consumtion of
contaminated human milk: summary of two outbreaks. National Nosocomial Infect
Study Report. 1978, Feb:14-5

Donowitz LG et al. Contaminated breast milk: A source of Klebsiella
bacteremia in a newborn intensive care unit. Rev Infect Dis 1981; 3(4):716-20

Moloney AC et al. A bacteriological examination of breast pumps. J Hosp
Infect 1987; 9(2):169-74

Ng PC et al. Bacterial contaminated breast milk and necrotizing enterocolitis
in preterm twins. J Hosp Infect 1995; 31(2):105-10

Graham JC. Sepsis and ECMO: beware the breast milk. J Hosp Infect 1999;
43(1):75-6

Jones BL et al. An outbreak of Serratia marcescens in two neonatal intensive
care units. J Hosp Infect 2000; 46(4):314-9

Olver WJ et al. Neonatal group B streptococcal disease associated with
infected breast milk. Arch Dis Child Fetal Neonatal Ed 2000; 83(1):F48-9

N-Y. Boo, A et al. Contamination of breast milk obtained by manual expression
and breast pumps in mothers of very low birthweoght infants. J Hosp Infect
2001;49:274-281

Le Thomas I et al. Breast milk transmission of a Panton-Valentine
leukocidin-producing Staphylococcus aureus strain causing infantile
pneumonia. J Clin Microbiol 2001; 39(2):728-9

Youssef RF et al. Expressed breast milk as a source of neonatal sepsis.
Pediatr Infect Dis J. 2002; 21(9):888-9

Nancy
Nancy E. Wight MD, FAAP, IBCLC
Neonatologist, Children's Hospital, and Sharp Mary Birch Hospital for Women
Medical Director, Lactation Services, Sharp HealthCare
San Diego, CA, USA

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