The problem with making claims with regard to the storage times for
unrefrigerated breast milk is all the "it depends" kind of things.  For one
thing, it depends on the room temperature.  Looking at the best of the milk
storage studies (Hamosh's particularly -- see ref. below) it seems clear
that above certain temperatures milk should not be held at room temperature
but refrigerated immediately.  Many mothers have cultural traditions about
keeping the room warm after the birth of a baby. In places like where Laurie
Wheeler and I live, in the southern US states, the ambient room temperature
might be quite warm.  Then there is the issue of especially virulent hospt.
germs.  Is everyone using great care in the pumping/hand expression and
collecting technique?

  We all know there are some babies who must receive early supplements
(hopefully exclusive human milk supps from own mom or an approved milk
bank.)  For these mothers whose infants have a medical necessity for safely
stored and handled human milk, why is infection control not trying to be
more proactive in helping you find the best and safest way to do this?  And
no one should take anyone's word for anything.  You should be willing to
provide data from the research lit.  (Yes, LLL prob. has a ref. but this is
a secondary ref. and open to interpretation.  It is better to cite primary
sources.)

Working together, not at cross purposes, is the way to proceed.  Cheerfully
provide the Hamosh article, which is creditable.  Let the infection control
person read the data and help you come up with a policy on how to safely
store the milk.  Hamosh's article (and data on cooling from the pump
companies who mfg coolers) suggests that milk is safe for 24 hrs or so at 25
degrees C (59degrees F).  A reasonable solution therefore might be to
provide or ask families to provide a small insulated bag (like the thermal
lunch boxes that cost under $10) or small styrofoam cooler with real or
artificial ice.  Then the milk would be isolated under the control of the
family, but kept cool enough to satisfy infection control of reduced risk of
bacterial overgrowth.  There is a sink with hot water in each room, so
warming would be no more difficult than at home.

M Hamosh, L Ellis D Pollock, T Henderson, et al:  Breastfeeding and the
Working Mother:  Effect of Time and Temperature of Short-term Storage on
Proteolysis, Lipolysis, and Bacterial Growth in Milk, Pediatrics 1996;
97(4):492.    Since Pediatrics is on-line, this article (look in their
Archives) should be very accessible.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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