Intestinal colonization patterns of staphylococci in preterm infants in relation to type of enteral feeding and bacteremia.

OBJECTIVE: This study investigated the intestinal colonization with staphylococci in very low birth weight infants in relation to the type of enteral feeding and evaluated the intestine as potential source for staphylococcal bacteremia. PATIENTS AND METHODS: Infants born in the Level III neonatal intensive care unit of a university hospital with a gestational age below 32 weeks and/or birth weight below 1,500 g were included in a prospective, observational study. The infants received either preterm formula or mother's own milk, with random allocation to raw or pasteurized milk. Precise viable staphylococcal counts of serial fecal specimens were examined in the first 8 weeks of life. In the case of bloodstream infection, fecal and blood isolates of staphylococci were compared by antibiotypes or pulsed-field gel electrophoresis. RESULTS: One hundred fifty neonates, with a mean of 29 weeks of gestation and 1,260 g at birth, had 1,045 fecal samples analyzed and were found to be heavy carriers of staphylococci in the intestine with 10(6)-10(7) colony-forming units/g of feces from the first week of life. Colonization rate and patterns were not different in relation to the type of enteral feeding. In nearly 80% of 42 patients exhibiting a staphylococcal bloodstream infection, intestinal colonization retrieved a predominant strain that was different from the one recovered from the blood. CONCLUSIONS: In very low birth weight infants, predominance of staphylococci in the gut is not related to the type of enteral feeding. An endogenous origin of staphylococcal bloodstream infection seems to play a minor role.

Pasteurization of mother's own milk for preterm infants does not reduce the incidence of late-onset sepsis.

BACKGROUND: Feeding preterm infants human milk has a beneficial effect on the risk of late-onset sepsis (LOS). Due to lack of microbiological standards, practices such as pasteurization of mother's own milk differ widely among neonatal intensive care units worldwide. OBJECTIVES: To investigate whether pasteurization of mother's own milk for very-low-birth-weight (VLBW) infants influences the incidence and severity of infection-related outcomes. METHODS: In this randomized controlled trial, preterm infants (gestational age <32 weeks and/or birth weight <1,500 g) received either raw or pasteurized mother's own milk during the first 8 weeks of life. The primary outcome was the incidence of proven LOS. A dose-response relation was verified, i.e. the dependence of the risk of sepsis on the actual and cumulative quantities of mother's own milk. RESULTS: This study included 303 VLBW infants (mean birth weight: 1,276 g; mean gestational age: 29 weeks) whose baseline and nutritional characteristics were similar. The incidence of laboratory-confirmed sepsis was not statistically different in infants fed raw milk compared to infants who received pasteurized milk: 22/151 (0.15, CI: 0.08-0.20) and 31/152 (0.20, CI: 0.14-0.27), respectively (RR: 0.71; 95% CI: 0.43-1.17). A significant dose-response relation was observed between the adjusted quantity of enteral feeding and the risk of LOS, regardless of the type of feeding. CONCLUSION: For preterm infants, pasteurization of mother's own milk shows a trend towards an increase in infectious morbidity, although no statistical significance was reached. Practices should focus on collection, storage and labeling procedures to ensure the safety and quality of expressed milk.

The use of human milk in the neonatal intensive care unit: practices in Belgium and Luxembourg.

BACKGROUND: Human milk remains the preferred feeding for all infants, including premature and sick newborns. However, mother's milk is not sterile, and expressed milk can be a source of commensal and pathogenic microorganisms. Microbiological quality standards for the use of expressed human milk in hospitals are not available, unlike for donor or formula milk. METHODS: To document current practices for the use of human milk in the neonatal intensive care units (NICU) in Belgium and Luxembourg, both for mother's own milk and donor milk, a questionnaire was sent to all 20 neonatal units. RESULTS: Of the 19 units that completed the survey, 47% perform bacteriological testing of expressed milk. Applied bacterial count limits for the acceptable level of contamination differ among units, for both commensals and pathogens. Only six units have a device for pasteurizing milk at their disposal. Storage time in the refrigerator for fresh milk varies between 24 hours to 7 days before use. Access to donor milk is limited. CONCLUSIONS: Routines for handling of human milk differ widely among NICUs in Belgium and Luxembourg. An assessment of current issues through a structured survey is a useful tool in the development of best practice guidelines.

Expressed breast milk on a neonatal unit: a hazard analysis and critical control points approach.

With the increasing use of human milk and growing evidence of the benefits of mother's milk for preterm and ill newborns, guidelines to ensure its quality and safety are an important part of daily practice in neonatal intensive care units. Operating procedures based on hazard analysis and critical control points can standardize the handling of mother's expressed milk, thereby improving nutrition and minimizing the risk of breast milk-induced infection in susceptible newborns. Because breast milk is not sterile, microorganisms can multiply when the milk is not handled properly. Additional exogenous contamination should be prevented. Strict hygiene and careful temperature and time control are important during the expression, collection, transport, storage, and feeding of maternal milk. In contrast to formula milk, no legal standards exist for the use of expressed maternal milk. The need for additional measures, such as bacteriological screening or heat treatment, remains unresolved.