When and why to do a breast milk test. What does a breast milk test show?

Seeding milk for sterility, doctor's opinion.

So, according to the WHO recommendations, all children should receive ONLY mother's milk (without additional water, juices and complementary foods) ON DEMAND (and not by the hour) from the mother's breast until 6 months of age. At the same time, breast milk does not belong to the sterile biological fluids of the body - therefore, sowing it for sterility is absolute nonsense! Since the ducts of the mammary glands open on the skin, they are colonized (and this is absolutely natural!) With normal skin microflora, which is usually represented by staphylococci (more often, of course, epidermal, but the presence of golden without any pathological manifestations also does not require the use of antibacterial therapy). Therefore, according to all international recommendations, microbiological examination of breast milk is not carried out at all.

Moreover, if the mother has lactostasis (a harbinger of mastitis) - the main recommended method of "treatment" is to apply the child to the SICK breast as often as possible to restore the normal secretion of milk from the affected departments - and at the same time no one is afraid that this milk may contaminated with the same staphylococci (the main causative microorganisms in mastitis) will somehow harm the child. And only if the problem cannot be solved and “classic” mastitis develops, requiring surgical intervention, then during the operation, pus can be taken, and feeding from the affected breast is stopped, replacing it with gentle pumping. Moreover, if the mother has sufficient motivation to maintain breastfeeding, it can be continued from a "healthy" mammary gland and resumed from the affected one as soon as possible after the acute infectious process has stopped. At the same time, penicillin antibiotics (oxacillin) used for mastitis AB therapy do not require mandatory cessation of breastfeeding.

Further, if we talk about the quantitative results of breast milk culture - I immediately have a question, how long did this milk deliver to the laboratory and how much time passed before culture? Milk, of course, is an excellent breeding ground for microbes, and the longer it was stored in a test tube (but not in the mother's breast), the more staphylococci multiplied there. Moreover, for sowing, most likely, they took the first portion of expressed milk, which is much more contaminated with normal microflora than milk from the deep sections of the mammary glands.

In general, such contamination of milk does not harm normal children without severe immunodeficiency in any way, since their own enzymes and other factors of nonspecific immunity, together with secretory IgA, lysozyme and other protective components of breast milk, do an excellent job with contaminating staphylococci. By the way, again, breastfeeding organizations criticize advice for mothers to wash their breasts with soap before and after feeding - this leads to a violation of the protection of the skin and the appearance of cracks (one of the risk factors for developing mastitis), while treating the nipples with breast milk saves necessary natural protection against infection.

Assistant of the Department of Clinical Pharmacology, SSMA,
senior researcher Research Institute of Antimicrobial Chemotherapy
PhD OU. Stetsyuk

About sowing breast milk for sterility

“Sowing milk for sterility”, aka “milk bacteriological testing”, aka “Bacteriological examination of breast milk”, etc.

Insanely popular analysis in the countries of the former CIS.
An insane amount of questions about him on the forum and in everyday practice.

There is no number of wasted nerves of mothers, drunk antibiotics and bacteriophages, injections of antistaphylococcal and simple immunoglobulins, and babies weaned for this reason.
They just give up and the tongue falls off - to explain the same thing, to contradict infectious disease specialists and fellow pediatricians. Prescribed most often for colic, low weight gain, regurgitation, "constipation" and so on - all of these are FALSE REASONS!

In terms of frequency of appointment, uselessness and stupid prescriptions based on it - only the notorious fecal analysis for dysbacteriosis can compete with this analysis. But as a basis for a medical ban on breastfeeding - this analysis is unrivaled. But this is a huge mass delusion, extremely widespread in our country!

So

1. The main thing to understand is that the sterility of breast milk is NOT NORM in itself. So to strive for it is illiteracy and stupidity.

Let's take a look at this quote from the source at the end of the post (page 9):

The bacteria are often asymptomatic in breast milk in both industrialized (144) and developing (184) countries. The spectrum of bacteria is often very similar in composition to skin bacteria (74; 100; 119; 170). Marshall (100), for example, discovered Staph. epidermidis, diphtheroids, alpha-hemolytic and non-hemolytic streptococci. Thus, carrying out bacteriological studies is complicated by the difficulty of avoiding the ingestion of bacteria from the skin (160). Despite the use of special methods for collecting milk for research, only 50% of milk cultures can be considered sterile (109), other samples contain a “normal” bacterial colony content of 0 to 2,500 colonies per ml (183).

Thus, the presence of bacteria in the milk does not necessarily indicate the presence of an infection, even if these bacteria have not entered the milk from the skin. One way to distinguish an infection from a simple bacterial colonization of the milk ducts is to look for bacteria coated with specific antibodies. As with urinary tract infections, the presence of IgA and IgG-coated bacteria in breast milk indicates a specific immune response to an existing infection (158; 160). However, in many cases
there is no equipment for such studies.

2. In the vast majority of cases, epidermal staphylococcus aureus (Staph. epidermidis) and Staphylococcus aureus (Staphylococcus aureus) are sown in this analysis.

Both of these opportunistic microorganisms can cause mastitis, you can not argue with that. However, you can’t argue with the fact that both of them (Staphylococcus aureus in 25% of cases, and epidermal in almost 100% of cases) are normal representatives of the human skin flora , that is, they are normally found on the skin (and on the areola of the nipple) of the mother.

This leads to 2 conclusions:

A) When passing the test, the mother, by decanting, can introduce bacteria into the initially sterile breast milk that were only on her hands and nipple, that is, the detection of microorganisms will be associated with a defect in the sampling of the analysis. But that doesn't matter at all, because:
b) a child who suckles the mother's breast - in any case licks these microorganisms from her areola even if the milk itself is completely sterile! And if so - it means that complaints from the child can almost never be associated with the analysis of breast milk culture.

3. Almost the only indication for this analysis are REPEATED MASTITIS IN THE MOTHER.

And only they. This is why opportunistic pathogens are called conditionally pathogenic because they cause disease only under certain conditions. Once in the milk ducts of a woman, they can live there without harming the mother and child. and may cause mastitis. Hence the conclusion - it is necessary to study the composition of the mother's milk flora only when there are purulent breast diseases (mastitis).

In other words: if the mother has recurring mastitis, then for the perfect antibiotic selection the doctor needs to know what flora is sown from milk and to what antibiotics it is sensitive. Almost in all other cases - this analysis does not carry any useful information and the mother can safely refuse to conduct it. Because it is often paid, and even harmful, since a number of doctors tend to forbid the mother to breastfeed the child, confirming the non-sterility of her milk. See reasons #1 and #2 in post #26

4. Oh, those "almost".

For the sake of fairness and completeness of the picture, it should still be noted that there are indications on the part of the baby for sowing mother's milk and even the abolition of breastfeeding based on its results. This is sepsis in an infant and purulent-inflammatory diseases of the skin in him, as well as a number of even more rare diseases. Knowing them is the doctor's task, you can't discuss everything in the FAQ.

But in the vast majority of cases, this analysis is prescribed without the slightest evidence, it is performed poorly and is interpreted extremely illiterately, and therefore most often it is absolutely not needed. Prohibiting breastfeeding according to its results means harming the baby, depriving him of completely harmless and extremely healthy food (if the child does not have recurrent purulent-inflammatory diseases, primarily skin diseases).

If you passed this analysis, and it is not vibrio cholerae, not salmonella, and so on - that is not obligate pathogen, and conditional- in 99 out of 100 cases, you should safely forget about its existence and continue to feed the child calmly.

… You can read more about the treatment of mastitis in nursing mothers in this WHO book:
Mastitis. Reasons and management.

PS It always amazes me that the same doctors who love to inoculate milk for microorganisms and forbid breastfeeding on this basis - never sow the contents of baby bottles, do not take swabs from them, and even quite often - do not explain that bottles, nipples, pacifiers and everything else REQUIRES REGULAR BOILING. There is no doubt that these bottles are WAY MORE CONTAMINATED than mom's milk, but this important fact is completely ignored.

This once again confirms the illiteracy of such colleagues, no matter how bitter it is to talk about it.

And about how useful mother's milk is for newborns. But in recent years, there has been an opinion that bacteria that multiply in breast milk can be dangerous for children, causing them to have dysbacteriosis and other problems with the gastrointestinal tract. More moms are doing analysis of breast milk for sterility, trying to find enterococci, epidermal staphylococci, E. coli, Staphylococcus aureus and Candida fungi in it.

The opinion of doctors about sterility was divided. Some believe that the analysis of breast milk is of no value, and can only become a reason for the unreasonable prescription of antibiotics to a nursing mother. Since breast milk is not originally a sterile product. The ducts of the mammary glands open on the skin, inhabited by various microbes - staphylococci, streptococci and fungi, which can almost freely enter the body. Therefore, it is simply meaningless to determine the degree of sterility of milk.

In addition, bacteria are unlikely to harm the baby, since hydrochloric acid destroys them in the stomach. Yes, and they get into the mouth of the crumbs, not only from the mother's breast, but also from other surrounding objects. We do not check for sterility the furniture in the house, the floor and children's toys that the child constantly licks. Therefore, to test the most valuable product - mother's milk, which itself is a source of antibodies, does not make any logical sense.

But some doctors still prescribe their patients to donate breast milk for analysis. Especially often this is done by women suffering, which is the most common complication after childbirth. At 2-4 weeks of the postpartum period, a woman's temperature rises to 38-39 degrees, chills appear, and after a few days pus appears in the milk. The main causative agent is Staphylococcus aureus. Also, often in women with mastitis, streptococcus, Pseudomonas aeruginosa, or enterobacteria are found in milk. All of them are highly resistant to antibiotics. Therefore, it is extremely important to accurately determine the pathogen, and to know its sensitivity to drugs. A nursing mother is treated while saving.

Where to take a breast milk test

The analysis is carried out in some private laboratories. Milk is collected at home using two sterile jars separately for each breast. Before use, the jars are boiled for 15 minutes or they are purchased at the pharmacy ready-made packaged containers for analysis. Before collecting milk, hands are thoroughly washed with soap, the areola area is wiped with a towel or sterile napkin. The first 10 ml of milk is pumped into the sink, and the second 10 ml into a jar.

The milk is then transported very quickly to the laboratory. No more than 2-3 hours should elapse between expressing milk and handing it over to the laboratory. Otherwise, the results may not be accurate enough. A response from the laboratory is expected for about a week. During this time, the samples are placed in a special environment where the bacteria grow rapidly. In parallel with determining the number of bacteria, experts conduct tests for their resistance to the effects of various drugs - antiseptics, antibiotics, etc. With the results of the analysis, the woman comes to her doctor, who prescribes the most effective course of treatment for her.

But in principle breast milk analysis for staphylococcus is absolutely not necessary. If the mother does not suffer from mastitis, then if the child complains of digestive problems, she is referred to a pediatric gastroenterologist. No milk sterility tests are required. The doctor prescribes a course of treatment for the child and advises giving the baby bifidobacteria and lactobacilli. not applicable in this case.

If a nursing mother has developed mastitis, you can pass the analysis. But in no case should you stop natural feeding, even if the sowing of breast milk has shown poor results. In any case, the benefits of mother's milk outweigh the harm from the microbes that enter the baby's body with it. Immunoglobulins, which are contained in breast milk, stimulate the metabolism, and also increase the child's resistance to infections.

If you want to make your milk more "sterile", better take care of. Stop eating sweets and pastries, which are ideal food for microbes. Don't drink carbonated drinks. Avoid foods containing preservatives and dyes. And very soon you will see that the child's well-being will improve. Also, take good care of your breasts. Wash your face before each feeding and wipe the areola area with an oil solution of vitamins A and E. This will make the skin of the nipples softer and prevent cracking.

Whatever arguments “for” and “against” the analysis of breast milk are given by doctors, the choice is yours. The main thing is not to rush to conclusions and not start taking dangerous antibiotics. Address only those doctors whom you trust, and they will definitely do everything possible to keep your baby healthy.

It used to be thought that breast milk was absolutely sterile, but numerous studies have proven that this is not entirely true. Milk can still contain various microorganisms. Basically, these are representatives of conditionally pathogenic microflora, which most often quietly exist on the skin, mucous membranes, in the intestines and do not cause any harm. However, under certain conditions (decreased immunity, chronic diseases, general weakness of the body after an infectious disease, intestinal dysbacteriosis), they begin to multiply rapidly, causing various diseases.
The main bacteria that can live in breast milk are: staphylococci (epidermal and aureus), enterobacteria, Klebsiella, fungi of the genus Candida.
The most dangerous of this company is Staphylococcus aureus. It is he who, having penetrated into the mammary gland, can cause purulent mastitis in a nursing mother. And once in the baby's body along with breast milk, staphylococcus aureus can cause diseases such as:

• enterocolitis (frequent, loose, watery stools, abdominal pain, fever, frequent regurgitation, vomiting);
• purulent inflammation on the skin;
• the phenomena of intestinal dysbacteriosis (accelerated stools, excessive gas formation, accompanied by bloating and discharge of a large amount of gases during defecation, frequent regurgitation, the appearance of undigested lumps in the feces, a change in the color of feces - yellow-green, the color of marsh mud). Staphylococcus aureus is protected from the outside by a capsule that helps it penetrate organs and tissues without being destroyed. After the invasion, it begins to release toxic substances that have a destructive effect on the structure of cells. This type of staphylococcus is very resistant to various external factors, and it can be very difficult to “expel” it from the body. Other microorganisms, having settled in breast milk, can also cause a lot of trouble.
• Mushrooms of the genus Candida, hemolyzing Escherichia coli and Klebsiella, which penetrate the baby with breast milk, are able to ferment glucose, sucrose and lactose, while forming a large amount of gas. This, in turn, causes pain, bloating and diarrhea in the child.

How do microbes get into milk?

Microorganisms enter breast milk mainly through the skin. This can happen if the baby is incorrectly applied to the breast, the breast is incorrectly removed from his mouth, and mistakes are made when caring for the mammary glands. In such cases, microtraumas and cracks in the nipples may appear, which are the entrance gate for the infection to enter the mammary glands and, accordingly, into breast milk.
Who "lives" in milk?
You can find out which microbes live in breast milk and in what quantity by doing a special study, the so-called sowing milk.

It allows you to detect various pathogens in it, determine their number and, if necessary, determine sensitivity to antibacterial drugs.
It is not at all necessary for all lactating women to take milk for analysis to find out if it is dangerous for the baby. Such a study should be carried out only in cases where there is a suspicion of infectious diseases in the baby or inflammatory diseases of the mammary gland in the mother.
In what cases is it necessary to hand over milk for analysis? The indications will be as follows.
From the side of the child:

• recurring purulent-inflammatory diseases of the skin;
• dysbacteriosis;
• prolonged diarrhea (frequent loose stools) with greens and mucus.

From mom's side:

• signs of mastitis (inflammation of the mammary gland) - chest pain, fever, redness of the skin of the mammary gland, purulent discharge from it.

How to collect milk for analysis?

When collecting breast milk for analysis, it is important to understand that it is necessary to try to exclude the possibility of bacteria from the skin entering the milk. Otherwise, the result of the study may be unreliable. There are certain rules for collecting breast milk for sowing.

1. First of all, you need to prepare a container for expressed milk. These can be sterile disposable plastic cups (you can buy them at a pharmacy) or clean glass jars that must first be boiled with a lid for 15–20 minutes.
2. There should be two containers for expressed milk, as the milk for analysis from each breast is collected separately. Containers should be labeled from which breast the milk was taken.
3. Before pumping, wash your hands and chest with warm water and soap.
4. The first 5–10 ml of expressed milk is not suitable for testing and should be discarded. After that, the required amount of breast milk (5–10 ml from each mammary gland is required for analysis) must be expressed into prepared sterile containers and tightly closed with lids.

In the laboratory, milk is sown on a special nutrient medium. After about 5-7 days, colonies of various microbes grow on it. Next, it is determined to which group of pathogens these microorganisms belong, and their number is counted.

Should you breastfeed with mastitis?

If germs are present in breast milk, a breastfeeding mother should consult a doctor. Only he can decide whether treatment is necessary or not. The World Health Organization (WHO) believes that the detection of bacteria in breast milk is not a reason to stop breastfeeding. The fact is that all pathogens, penetrating the body of a nursing mother, stimulate the production of special protective proteins - antibodies that get to the baby during feeding and protect him. That is, if some microorganisms are found in the milk, but there are no signs of disease (purulent mastitis), breastfeeding will be safe, since the child receives protection from infections along with milk.

If staphylococcus is found in breast milk, treatment with antibacterial drugs is prescribed only in case of purulent mastitis in the mother, when she has signs of infection. At the same time, doctors recommend temporarily (for the duration of the mother's treatment with antibiotics) not to put the baby to the diseased breast, to regularly express milk from it, but to continue to feed him from a healthy mammary gland.

In cases where the symptoms of a staphylococcal infection are found in both the mother and the child, the mother and baby are treated simultaneously. At the same time, this disease can manifest itself in a child in different ways:

• inflammation of the mucous membrane of the eyes (at the same time, the eyelids swell and the eyes fester);
• inflammation of the area around the navel (the skin in this place swells, turns red and pus is released from the umbilical wound);
• purulent-inflammatory skin lesions (bubbles of various sizes appear on the baby's skin, filled with purulent contents, and the skin around them turns red);
• inflammation of the small and large intestines (in this case, abundant watery stools appear up to 8-10 times a day, maybe with an admixture of mucus and blood, vomiting, abdominal pain).

To confirm the diagnosis and determine the pathogen, the doctor may prescribe a culture of the inflammation separated from the focus (eyes, umbilical wound, the contents of the vesicles on the skin). And in case of violation of the intestines in the baby, a fecal analysis for the microflora is prescribed.

How to keep milk "clean"

In order for the milk to remain “pure” and it was not necessary to interrupt breastfeeding, depriving the baby of the best food for him, a nursing mother can be advised to follow a diet with a restriction of sweet, starchy and rich foods, as their abundance creates a favorable environment for the reproduction and growth of microbes.
It is also important to prevent the formation of cracked nipples. And for this you need to properly attach the baby to the breast (at the same time, the baby captures most of the areola, and not just the nipple, its lower lip is turned outward, and the nose touches the chest) and follow a few rules when caring for the mammary glands (wash the breast no more than 1– 2 times a day; arrange air baths for the nipples after feeding and between them; lubricate the nipples after feeding with drops of "hind" milk released at the end of feeding, as it has protective and healing properties and protects the nipple from dryness; do not apply to treat the nipple and areola, various disinfectants - brilliant green, alcohol, etc., as this contributes to the drying of the skin of the nipple and areola, followed by cracking).
If cracks nevertheless appear, then it is necessary to treat them in a timely manner in order to prevent infection and the development of mastitis.

Should I be treated if nothing hurts?

When staphylococcus aureus is present in breast milk, but there are no signs of infection in a nursing woman, breastfeeding is not stopped, but at the same time, as a rule, the mother is prescribed treatment (orally and locally) with drugs from the group of antiseptics that are not contraindicated in breastfeeding, and the child is given a doctor prescribe probiotics (bifido- and lactobacilli) for the prevention of dysbacteriosis.

Many women think that if there are no signs of a disease, then treatment can not be carried out. However, this opinion cannot be considered correct. The problem is that in such a situation, the mother’s condition will not worsen, but the baby can be harmed. If a child is fed infected milk for a long time, then the composition of bacteria in his intestines may be disturbed and the body's defenses will fail. Therefore, the mother must be treated without interrupting breastfeeding.

We evaluate the result of the analysis of breast milk

What can be seen on the analysis form that comes from the laboratory?

• Option 1. When sowing milk, no growth of microflora is observed, i.e. milk is sterile. It should be noted that this result of the analysis is very rare.
• Option 2. When sowing milk, the number of non-pathogenic microorganisms (epidermal staphylococcus aureus, enterococci) increased insignificantly. These bacteria are representatives of the normal microflora of the mucous membranes and skin and do not pose a danger.
• Option 3. When sowing milk, pathogens were found (Staphylococcus aureus, Klebsiella, hemolyzing Escherichia coli, fungi of the genus Candida, Pseudomonas aeruginosa). Their allowable content in breast milk is no more than 250 colonies of bacteria per 1 ml of milk (CFU / ml).

Each of us knows how beneficial breastfeeding is for babies. However, recently, medicine has come to the conclusion that the bacteria found in breast milk can pose a danger to the health of babies, causing various diseases of the gastrointestinal tract. In this regard, many breastfeeding women prefer to take breast milk tests, checking it for sterility.

At the same time, it is important to understand that breast milk cannot be absolutely sterile, since the excretory streams of the mammary gland are on the skin inhabited by a wide variety of microorganisms. Therefore, the presence of microbes is completely normal. The main thing is that their content in milk does not exceed the permissible limits.

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What do breast milk tests mean?

Analysis of breast milk allows you to determine the number of microbes contained in it:

• staphylococci;
• streptococci;
• fungi;
• coli;
• enterococci.

What is the principle of analysis?

To test breast milk for sterility, it is necessary to hand over a small amount of it for analysis. Under laboratory conditions, milk is placed in a nutrient medium and stored for some time in an incubator. After a few days in a nutrient medium (as required by the analysis), whole colonies of a wide variety of microbes appear. After recounting the formed microbes, it is possible to determine the average indicator of their existence in the composition.

Breastfeeding mother's milk analysis requires care and precision during its collection. Only in this way can the reliability of the analysis performed be guaranteed. The collection mechanism must completely exclude the possibility of getting into the sample of microorganisms from the surface of the skin of the hands or chest. The necessary sterility is achieved through the use of exceptionally clean containers and thoroughly washed and alcohol-treated hands.

When is such an analysis necessary?

There are several cases when breastfeeding mothers are advised to take an analysis for the sterility of breast milk:

• in case of purulent mastitis transferred by a nursing woman;
• in case of sepsis or purulent-inflammatory diseases in a child;
• in case of manifestation in the baby in the first two months of his life of an unstable stool, diarrhea, constipation, colic (where the feces are dark green with blood or mucus impurities);
• in case of slight weight gain during the first months of life.

Breast milk research at the Clinic of Modern Medicine

The Clinic of Modern Medicine IAKI offers many qualified services, one of which is the analysis of breast milk for sterility. Our experienced professionals always recommend milk testing to nursing mothers, even in the absence of alarming symptoms. Caring for the health of babies, our doctors strive to completely eliminate the likelihood of various diseases in the first months of their lives.

If the analysis of breast milk shows a high content of harmful microorganisms in it, our specialists will offer an effective course of treatment using modern methodologies and advanced drugs. The action of the proposed drugs is not able to affect lactation and the health of the baby. Therefore, during treatment, milk remains suitable for feeding the baby. Only in the most extreme cases can antibiotics be prescribed, which require interruption of feeding.

In the future, to ensure that breast milk remains sterile, our doctors will advise a nursing woman on proper nutrition and proper care of her breasts.