Donated breast milk stored in banks versus breast milk purchased online

Question

One of my patients asked if she could buy human milk on the Internet to feed her infant if the need arose. Is using donated breast milk from the milk bank safer than buying it online?

Answer

The World Health Organization and the American Academy of Pediatrics recommend the use of donated breast milk as the first alternative when maternal milk is not available, but the Canadian Paediatric Society does not endorse the sharing of unprocessed human milk. Human breast milk stored in milk banks differs from donor breast milk available via the Internet owing to its rigorous donor-selection process, frequent quality assurance inspections, regulated transport process, and pasteurization in accordance with food preparation guidelines set out by the Canadian Food Inspection Agency. Most samples purchased online contain Gram-negative bacteria or have a total aerobic bacteria count of more than 10⁴ colony-forming units per millilitre; they also exhibit higher mean total aerobic bacteria counts, total Gram-negative bacteria counts, coliform bacteria counts, and Staphylococcus spp counts than milk bank samples do. Growth of most bacteria species is associated with the number of days in transit, which suggests poor collection, storage, or shipping practices for milk purchased online.The World Health Organization and the American Academy of Pediatrics recommend the use of donated breast milk as the first alternative when maternal milk is not available.¹ Human milk is recognized for its numerous benefits including inducing tolerance to allergens, providing passive immunization, improving lipid profiles, and controlling blood pressure.² In studies conducted in neonatal units, infants who were fed human breast milk had fewer severe infections, less necrotizing enterocolitis, and less colonization by pathogenic organisms.³ However, more than 2 decades after fears of HIV transmission forced the closure of all but 1 of Canada’s milk banks, health professionals and parents remain divided on the safety of sharing breast milk.⁴ Breast milk is still easily available online (eg, www.eatsonfeets.org; http://hm4hb.net).The Canadian Paediatric Society notes the following:

The preferred nutrition for the newborn is his/her own mother’s milk. When this is not available or is limited, pasteurized human donor breast milk is a recommended alternative for hospitalized neonates  .… The Canadian Paediatric Society does not endorse the sharing of unprocessed human milk.³

The Canadian Paediatric Society also recommends the following:

The use of pasteurized human donor breast milk should be prioritized to compromised preterm infants and selected ill term newborns.³Pasteurized human donor breast milk should only be prescribed following written informed consent from a parent or guardian.³Education of parents about the benefits of human breast milk or pasteurized human donor breast milk is essential to parental choice and informed decision making in prescribing an optimal feeding plan for hospitalized neonates.³

     

Passage of cows' milk protein in breast milk

An enzyme-linked immunosorbent assay has been used to search for lactoglobulin and bovine casein in breast milk. Initial results suggest this may be a simple and useful method for such studies. Detection and prevention of antigen passage could influence the prevalence of atopic disease.     

gamma-Glutamyltransferase in breast milk

The activity of gamma-glutamyltransferase was measured in a series of human breast milk samples collected during the first post natal week. All the samples showed considerable gamma-glutamyltransferase activity. The mean level fell from 28.8 U/ml to 3.9 U/ml seven days later. There was a highly significant correlation between gamma-glutamyltransferase and the protein content of the samples studied.     

Chlorinated hydrocarbons in breast milk

Chlorocarbons, which are used for cleaning purposes in both the home and industry, are of growing interest with respect to environmental pollution. We have therefore, compared the concentrations of chloroform (CH CL3), carbon tetrachloride (C CL4) and tetrachloroethylene (C2 CL4), determined by gas chromatography, in breast milk from 13 puerperal mothers from Innsbruck and the surrounding Tyrol with the respective data in 20 mothers from Linz and the surrounding industrial area. In fact, no elevation in chlorocarbon levels was detected in either group.     

Transfer of probenecid and cephalexin into breast milk

OBJECTIVE: To report a case of the transfer of probenecid and cephalexin into human milk. CASE SUMMARY: A breast-fed infant of a 30-year-old woman being treated with oral probenecid and cephalexin for a breast infection developed severe diarrhea and associated symptoms. To investigate whether the maternal drug treatment was causative, milk was collected over a dose interval at steady-state, and concentrations of probenecid and cephalexin were measured by HPLC. The average concentrations of probenecid and cephalexin in milk were 964 and 745 microg/L, respectively, corresponding to absolute and relative infant doses of 145 microg/kg/day and 0.7% for probenecid and 112 mug/kg/day and 0.5% for cephalexin. The infant's adverse effects were rated as possible for probenecid and probable for cephalexin based on the Naranjo probability scale. DISCUSSION: On the basis of the calculated relative infant doses for both probenecid and cephalexin in milk and the notional 10% level of concern for infant exposure, neither drug would be expected to cause significant systemic effects. However, local adverse effects, notably diarrhea, were observed. The Naranjo probability scale rating suggested that cephalexin was more likely than probenecid to be the cause of the infant's diarrhea. CONCLUSIONS: When using cephalexin/probenecid to treat breast infections in lactating women, clinicians should anticipate the possibility of adverse gastrointestinal effects in the breast-fed infant.     

Transfer of glyburide and glipizide into breast milk

OBJECTIVE: To determine if glyburide and glipizide are excreted into breast milk and if breast-feeding from women taking these drugs causes infant hypoglycemia. RESEARCH DESIGN AND METHODS: We studied eight women who had received a single oral dose of 5 or 10 mg glyburide. Drug concentrations were measured in maternal blood and milk for 8 h after the dose. In a separate study, five women were given a daily dosage (5 mg/day) of glyburide or glipizide, starting on the first postpartum day. Maternal blood and milk drug concentrations and infant blood glucose were measured 5-16 days after delivery. RESULTS: In the single-dose glyburide study, the mean maximum theoretical infant dose (MTID) as a percent of the weight-adjusted maternal dose (WAMD) was <1.5 and <0.7% for the 5- and 10-mg doses, respectively. For the five women taking daily dosages, the mean MTID as a percent of the WAMD was <28% for glyburide and <27% for glipizide. The high estimates were due to the insensitivity of the assay. Neither glyburide nor glipizide were detected in breast milk in either study and blood glucose was normal in the three infants (one glyburide and two glipizide) who were wholly breast-fed when the drug concentrations were at steady state. CONCLUSIONS: Neither glyburide nor glipizide were detected in breast milk, and hypoglycemia was not observed in the three nursing infants. Both agents, at the doses tested, appear to be compatible with breast-feeding.     

推拿手法干预产妇母乳不足效果分析

<正> 哺乳早期,部分产妇由于受精神因素、自身因素(如乳头凹陷)以及缺乏母乳喂养知识与技巧不能正常的哺乳,影响婴儿的健康成长。笔者采取中医推拿手法配合中药食疗治疗母乳不足,效果良好。现总结如下。     

Gliadin-specific IgA antibodies in breast milk

Breast-feeding helps to protect against coeliac disease because of the presence of antigliadin-IgA antibodies (AGA-IgA) in breast milk. The aim of this study was to assess the concentrations of AGA-IgA in breast milk during lactation, and whether these concentrations vary with the socioeconomic status of the women. Samples of serum for determination of IgA albumin and AGA-IgA, and samples of breast-milk for AGA-IgA were collected from 105 healthy mothers (aged 17 - 36 years). Women were divided into two groups: group 1 were of low and group 2 were of high socioeconomic status. No differences were observed between the study parameters in the two groups. Serum AGA-IgA in both groups was, however, significantly lower than that in colostrum. AGA-IgA concentrations in both groups gradually decreased during 45 days of lactation; the difference between colostrum and the samples taken at days 10 and 30 - 45 of lactation was significant. The encouragement of sufficient and long-term (e.g. 4 - 6 months) breast-feeding seems likely to be beneficial in preventing coeliac disease.     

Ceftazidime levels in human breast milk

Ceftazidime in the breast milk of 11 puerperal women were determined by bioassay. Each patient received 2 g of ceftazidime intravenously every 8 h for 5 days. The mean (+/- standard deviation) ceftazidime concentrations in the milk were: 3.8 +/- 2.0 (before the next dose), 5.2 +/- 3.0 (1 h after), and 4.5 +/- 1.7 micrograms/ml (3 h after). Ceftazidime was excreted in breast milk at relatively constant levels between days 2 and 4 of therapy.     

Flecainide excretion in human breast milk

Healthy human volunteers who intended not to breast feed were placed on a regimen of 100 mg oral flecainide every 12 hours for 5 1/2 days beginning 1 day after parturition. Milk and blood samples were collected during the dosing period and for 2 days after the last dose. Concentrations of flecainide in milk and plasma were assayed by HPLC. Apparent steady-state levels of flecainide in both milk and plasma were achieved in most cases by day 4 of the study. Highest daily average concentration of flecainide in milk ranged from 270 to 1529 ng/ml for the 11 subjects. Mean +/- SD milk to plasma flecainide ratios were 3.7 +/- 3.5, 3.2 +/- 2.3, 3.5 +/- 2.1, and 2.6 +/- 0.7 on study days 2, 3, 4, and 5, respectively. After the last dose of flecainide, peak milk levels of the drug occurred at 3 to 6 hours and then declined monoexponentially. The half-life for elimination of flecainide from milk was 14.7 +/- 3.5 hours and is very similar to the plasma elimination half-life of flecainide in healthy human subjects. The mean milk to plasma ratios for flecainide after the last dose were 2.3 +/- 1.0 and 2.9 +/- 1.1 at 24 and 48 hours after the dose, respectively. Based on the pharmacokinetics of flecainide in infants, the expected average steady-state plasma concentration of flecainide in a newborn infant consuming all of the milk production of its mother (approximately 700 ml/day) would not be expected to exceed about 62 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)