Ann writes: Our breastfed VLBW babies have a =
high incident of infection, feeding intolerances, smelly stools, etc.  =
The nurses have lost faith in mother's milk for the preemies.

I would be very interested in more details Ann. Do these VLBW (very low birth 
weight) babies have a higher incidence of infection than their counter parts 
fed formula. Are they receiving mixed feeds. What type of infections? What is 
the definition of feeding intolerance and what is your protocol for advancing 
feeds? Is this increased infection rate a sudden change? If the milk is truly 
contaminated your infectious disease team better quickly get their hands on 
the pumps and culture them. Are you using hospital grade pumps where no milk 
should be able to get into the motor? Breast milk is not a sterile fluid but 
there are acceptable colony counts for certain bacteria. There is good info in 
Lawrence on this.  In a few instances where we've been concerned about 
contaminated milk we've collected a clean catch from each breast. It sounds like you've 
taught the mothers to use good technique to collect their milk. Are your 
freezers working properly and are the refrigerators at the right temperature? Is 
there something in the feeding method that could be causing a 
problem--continuous feeds left in the tubing too long? My guess is if this is a true problem of 
contaminated milk it's probably, as the nurses think, pump related.  Somebody 
better quickly culture those pumps. 

Kathy Boggs, RN, IBCLC 

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