In the Human Milk Banking Association of North America, Inc.'s
publication, "Recommendations for Collection Storage and Handling of a
Mother's Milk for Her Own Infant in the Hospital Setting" routine
bacteriologic screening of expressed mother's milk is NOT recommended.

First, it gives the mother a message that 1) her milk is contaminated
and 2) that she cannot be trusted to follow instructions for the welfare
of her baby.  There are also no generally agreed upon "safe" bacterial
levels, and we would feel that 10 to the third (1000) CFU/ml as cited on
p. 259 of Riordan and Auerbach is outrageously conservative and would
mean that a lot of milk is thrown away. (Pardou et al, [1994, Biol
Neonate] discard expressed milk for premature infants only if colony
counts exceed 100,000 CFU.ml! a BIG difference.)

Secondly, routine screening programs may preclude feeding fresh milk to
infants if it takes longer to receive bateriologic results than the
shelf life of refrigerated milk.

Third, routine bacteriological screening is not cost effective.  In an
excellent Canadian study, over 10,000 individual feedings of fresh milk
were cultured.  There was no relationship found between the feedings,
the bacteria present in the feedings, and the 10 cases of sepsis in the
99 infants studied.  Septic infants were either septic from organisms
with which they were colonized prior to feeding, or were septic with
organisms that were antibiotic resistant when all feedings had contained
organisms that were antibiotic susceptible.  Before routine culturing is
instituted, please read the paper:

Law, BJ, Urias BA, Lertzman J, et al:  Is ingestion of milk-associated
bacteria by premature infants fed raw human milk controlled by routine
bacteriologic screening?  J Clin Microbiol 27:1560-1566, 1989.

Also, Lucas and Schanler also recommend placing the infusion pump below
the level of the infant (= isolette mattress) with the syringe pointing
up, so that milk fat rises to the top and is pushed through first.
Besides using small lumen tubing, excessive length of tubing  should be
avoided.

Cheers, Lois Arnold, MPH, IBCLC, Executive Director
The Human Milk Banking Association of North America, Inc. (HMBANA)