Bonny:  All of your questions are good ones, and I am not an expert to
answer them point by point.  Your questions about what happens to the
various components of human milk when pasteurized are well covered in the
Riordan and Auerbach "brown bible".  I am glad that you raised the issue
of pasteurization as an option because if one was really concerned about
infecting the baby, that would still be far preferable to abm.

Clearly, there are no easy answers and each case must be individualized.
However, I believe that what you read in Lawrence about culturing
staph from human milk applied to mastitis, not to this mother's situation
(I would need to reread the original post, but I didn't get the impression
that this mother's MRSA infection was in the breast itself).  So if we're
really dealing not with a mother whose breast is inflamed and "leaking"
staph into the milk, but rather a mother with normal breasts who may be
bacteremic, the question is how much staph from her bloodstream would
"leak" into the milk.  Although I don't have the answer, I would be
surprised if there would be much if any entry.  But even for argument's
sake if some should get into the milk, the milk itself has macrophages and
other antimicrobial factors, so it's not a matter of the baby's stomach
having to defend itself on its own.  Unless the mother is too ill to
nurse, she's probably mounting an immune response to her disease, which
would help the baby.  And if MRSA is around, then the baby is at risk of
contracting it from other sources.  In that case, his best defense might
be his own mother's milk. If the baby is compromised, premature, etc, as
you pointed out, we have to balance the risk of being infected through the
milk vs. the risk of having to battle numerous other nosocomial nasties
without the benefits of its mother's milk.  Remember, premature babies who
were artificially fed had much more sepsis and 20 times the necrotizing
enterocolitis of their breastfed counterparts.  And that's not to mention
the risks of allergic reactions to the abm.

You also raised the issue of the antibiotics being used.  I think it would
help to know which medication both the mother and the baby are getting, in
order to try to make a risk determination (Dr. Hale's help would be
invaluable).

This is not to minimize your concerns, which are very valid ones.  It's
important to take each case individually and weigh the risks and benefits.
I'm sure Dr. Jack will put this in his inimitable eloquent manner, but the
bottom line is we have to look not only at the potential risk of infecting
the baby through the mother's milk, but to try to put it into the
perspective of all the well known and documented risks of abm.  Regards,
Alicia Dermer, MD, IBCLC.