Microbial contamination of human milk purchased via the Internet

Abstract

Objective: To quantify microbial contamination of human milk purchased via the Internet as an indicator of disease risk to recipient infants.

Methods: Cross-sectional sample of human milk purchased via a popular US milk-sharing Web site (2012). Individuals advertising milk were contacted to arrange purchase, and milk was shipped to a rented mailbox in Ohio. The Internet milk samples (n = 101) were compared with unpasteurized samples of milk donated to a milk bank (n = 20).

Results: Most (74%) Internet milk samples were colonized with Gram-negative bacteria or had >10(4) colony-forming units/mL total aerobic count. They exhibited higher mean total aerobic, total Gram-negative, coliform, and Staphylococcus sp counts than milk bank samples. Growth of most species was positively associated with days in transit (total aerobic count [log10 colony-forming units/mL] β = 0.71 [95% confidence interval: 0.38-1.05]), and negatively associated with number of months since the milk was expressed (β = -0.36 [95% confidence interval: -0.55 to -0.16]), per simple linear regression. No samples were HIV type 1 RNA-positive; 21% of Internet samples were cytomegalovirus DNA-positive.

Conclusions: Human milk purchased via the Internet exhibited high overall bacterial growth and frequent contamination with pathogenic bacteria, reflecting poor collection, storage, or shipping practices. Infants consuming this milk are at risk for negative outcomes, particularly if born preterm or are medically compromised. Increased use of lactation support services may begin to address the milk supply gap for women who want to feed their child human milk but cannot meet his or her needs.

Keywords: Internet; aerobic bacteria; breastfeeding; human milk; infant.

FIGURE 1

Geometric mean bacteria counts (SEs) for human milk samples purchased via the Internet (n = 101) and acquired from a milk bank (n = 20). Results of the Satterthwaite t test for unequal variances reported. Error bars represent SEM.

FIGURE 2

Distribution of bacteria counts by bacteria type for human milk samples purchased via the Internet (n = 101). Salmonella sp was detected in 3 samples (counts not shown).