Last year I learned that Norway is one of the few countries that doesn't
pasteurize donor milk, because the immunologic properties are so greatly
reduced by pasteurization.  I am wondering whether the milk samples that
were contaminated with pathogens (in the references provided by Nancy
Wight), had been pasteurized, possibly before the contamination was
introduced.  It would be of interest to know whether the contamination was
done by the mothers in connection with expressing, or whether the bugs were
in the milk as it left the breast, or whether they jumped in later, during
handling by staff of the ward or the bank.  Thus I am particularly
interested in cases of babies who have developed infections after being fed
mother's milk straight from the breast, where it could be shown that the
offending organisms were in the milk before it was out of the breast.

I plan to read the article about the baby who got pneumonia (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) because I have heard of several mothers with mastitis who
have been told recently that their milk can make their baby seriously ill if
they continue to breastfeed during the mastitis.

There was a case in Seattle about 23 years ago of a baby who died of HSV-2
infection, caught from the mother's nipple.  It was not in the milk.  Father
had HSV-2 lesions orally, inoculated mother's nipple through direct
mouth-to-breast contact, and it turned out mother had never had HSV before.
Thus she had no antibodies she could have protected the baby with, and when
the baby was inoculated by nursing on the newly-infected nipple, the virus
had a field day.  I haven't followed the literature on HSV so don't know
about the infection of a baby through milk.

Some years back there was an epidemic of E.coli enteritis in a NICU in Oslo.
The bacterium was not the E.coli normally found in Norway, but was very
frequently present in the guts of women from Pakistan.  One baby on the ward
had it as the mother was from Pakistan, and the staff spread the infection
to a number of others.  Cramped quarters and not good enough handwashing
were probably to blame.  The epidemic was effectively eradicated by giving
fresh expressed breastmilk from a woman from Pakistan to all the babies in
the unit.  I heard the story from one of the pediatricians involved but have
no idea whether it has been published as a case report.

Rachel Myr
Kristiansand, Norway

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