I need some information (already searched the archives and have checked
Lawrence and Riordan and Auerbach) and can't find exactly what I'm looking
for.. First, could any of you who have policies regarding bacterial counts in
expressed milk for very low birth wt. babies share those with me.  Also,
would like to hear from NICU's who do surveillance cultures on expressed milk
and specifically what you consider safe for the tiny compromised premie.

In our 60 bed NICU and step down unit, we encourage all mothers to express
milk and we do not do any routine cultures--we teach handwashing and thorough
cleaning of the equipment. Mothers pump into sterile plastic bottles.  Over
the last several months our neonatologists have asked the lactation
consultants to obtain milk cultures on two mothers of very premature babies
(25-27 weeks).  The first baby had repeated episodes of sepsis which
responded to antibiotics although I seem to recall that they were never able
to isolate a bug in the baby. We determined that mother was using excellent
technique, but milk repeatedly grew staph aureus. Eventually as baby became
bigger the neonatologists encouraged the mother to give fresh milk, but she
insisted on pasteurization by our local milk bank. To collect the milk for
culture we did a clean mid stream catch into a sterile specimen container. .
Culture remained positive and all I remember was that it was higher colony
count than deemed safe in Ruth Lawrence.

The next mother had 27 week twins, one of whom died of NEC and E coli sepsis.
We have repeatedly cultured mom's milk using above technique and it
continually comes back positive for Klebsiella among other things.  Everybody
wants the living twin to get mom's milk but neonatologists feel they have
opened a can of worms and are not sure of how to safely deal with it.  Since
we don't do routine cultures we have no idea what is growing in the milk we
give our premies. This will probably come up again and we need some
guidelines. This second mother pointed out to us that she had spent most of
her life in India and wondered if possibly she has different bugs due to a
different "bacteriologic environment"...good question.  First mother was also
East Indian.

Am anxious to hear from anyone with policies or insight and especially from
our breastfeeding friendly neonatologists on the list.   And does anyone have
Paula Meier's e mail address?

Thanks and  please post to the list...I agree with whoever said that the
responses to these questions are helpful to everyone.

Kathy Boggs, RN, IBCLC

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