Analysis of breast milk for sterility. Milk is suspect

Nomenclature of the Ministry of Health of the Russian Federation (Order No. 804n): A26.30.009 "Microbiological (cultural) examination of breast milk for aerobic and facultative anaerobic microorganisms"

Biomaterial: Breast milk

Completion time (in the laboratory): 4 w.d. *

Description

A method for diagnosing postpartum (lactation) mastitis resulting from microorganisms entering breast milk. The most common causative agents of postpartum mastitis in women are Staphylococcus aureus, Pseudomonas aeruginosa and coliform bacteria. This study makes it possible to identify, calculate the concentration and assess the etiological significance of the isolated microorganism, and determine the sensitivity of the pathogen to antibiotics. The study allows the doctor to decide whether to stop breastfeeding.

Attention!
If growth of representatives of normal bacterial flora, characteristic of the material and location, is detected, regardless of its concentration, sensitivity to antibiotics and bacteriophages is not carried out.

If opportunistic microflora is detected in a diagnostically insignificant low titer or microflora is isolated below the established reference interval, sensitivity to antibiotics and bacteriophages is not determined (based on Order of the Ministry of Health No. 535 of April 24, 1985 “On the unification of microbiological (bacteriological) research methods used in clinical diagnostic laboratories of treatment and preventive institutions).

Indications for use

• Suspicion of the bacterial nature of inflammation of the mammary gland during lactation to determine the pathogen and select adequate antibacterial therapy.

Preparing for the study

Breast milk is collected on the day of the test, only before the baby is fed or two hours after breastfeeding.

Wash the mammary glands with warm water and soap, blot the skin with a sterile napkin or a clean towel, previously ironed. Carefully treat the nipples and the surrounding area of ​​the mammary glands with separate cotton swabs moistened with 70% ethyl alcohol. Pour out the first 5-10 ml of expressed milk, express the next 3-4 ml into separate sterile containers. Label the containers, indicating the material obtained from the right and left mammary glands.

Interpretation of results/Information for specialists

Taking antibacterial drugs may affect the results of the study.

Interpretation of results:

Increasing reference values:
Isolation of representatives of pathogenic flora indicates the etiological factor of the isolated pathogen in the clinical picture. The decision on the determination of sensitivity to antibacterial drugs is carried out by a microbiologist and is regulated by methodological guidelines. R-pathogen, S-pathogen is sensitive, I-pathogen is moderately resistant to the antibacterial drug. Identification of opportunistic flora and its significance in the development of the disease depends on the amount of pathogen isolated for a given location.

Reduction of reference values:
The absence of pathogenic flora is the norm. The presence of opportunistic flora in an amount not exceeding the diagnostic value is the norm for a given location

Most often ordered with this service

* The website indicates the maximum possible period for completing the study. It reflects the time it takes to complete the study in the laboratory and does not include the time for delivery of the biomaterial to the laboratory.
The information provided is for reference only and is not a public offer. For up-to-date information, contact the Contractor's medical center or call center.

Sowing breast milk is appropriate and justified only for persistent infectious mastitis that cannot be treated with standard antibacterial drugs. In all other cases, bacteriological examination of breast milk, which in many laboratories is called sterility culture, does not make sense. In fact, based on the purpose of this study, we can say that the specialist is not friendly to breastfeeding. The fact is that breast milk is initially a non-sterile biological fluid. It cannot be otherwise - the child’s intestines are populated with beneficial flora, including from mother’s milk. The mammary gland is a branched system of ducts, each duct is separate from the other. And even if there is an infection in one duct, the anti-inflammatory factors in the milk from the other ducts destroy the germs. In addition, the reliability of the study suffers greatly from incorrectly collected biological material. How should you take a bacteriological analysis of milk? It is necessary to express in different containers - milk from different breasts is collected separately. No matter how you express your milk, the sample inevitably becomes contaminated - either from your hands or from the breast pump, various microorganisms that are usually not present in milk or are present in smaller quantities get in. Let’s say the mother disinfected her hands, breasts, and breast pump as much as possible and expressed the first milliliters of milk “contaminated” with bacteria living on the skin. In order for the analysis to be as objective as possible, the sample must get to the laboratory as quickly as possible. In practice, it happens differently: the mother expressed milk, then one of the relatives took the milk to the laboratory - this is at least 1-1.5 hours. While the paperwork for the analysis is being completed, time also passes. The sample is then sent to the laboratory. If you take tests in laboratory offices remote from the laboratory, it will take time before the sample reaches the laboratory - at best, an hour, and usually several hours. After the courier delivers the sample to the bacteriological laboratory, work begins with it. So, from the moment of pumping to the receipt of the material for work, at least 3 hours pass. During this time, microorganisms multiply, increasing the microbial number. A reasonable question is why this does not happen when taking samples from other parts of the body? Because usually the inoculation is taken directly into test tubes with a nutrient medium, which promote the growth of pathogenic, disease-causing microbes. So, not without difficulty, the breast milk that reached the laboratory was inoculated on a nutrient medium, colonies of microorganisms were grown, they were identified and a certain result was obtained. There are no norms or standards regarding which microorganisms and in what quantities should be present in breast milk. Abroad, they generally do not carry out this expensive analysis unless it is necessary - the presence of a persistent, untreatable infectious process. It is clear that if clearly harmful microbes grow, the situation may require one or another treatment. But most often opportunistic microorganisms are sown, which in certain quantities do not interfere with either mother or child. Moreover, there may be more of them in the sample than is actually present in the milk. And a doctor who has insufficient knowledge in the field of lactation medicine, having received such a result, will be happy to take on the treatment of a situation that actually does not require correction. It happens that when staphylococcus is detected in milk, mothers are offered to feed the baby with their expressed pasteurized milk, although this labor-intensive procedure in this case will be unnecessary. Since the procedure is labor-intensive, most likely the mother, who is not sufficiently motivated and confident in herself and her abilities, will transfer the child to artificial nutrition and the doctor will receive another “convenient” controlled baby. Doctors who support breastfeeding do not prescribe expensive tests that produce unreliable results and, moreover, do not “treat” tests without severe symptoms in the mother. Even infectious mastitis does not require any tests at the beginning of treatment - if necessary, broad-spectrum antibiotics that are compatible with breastfeeding are prescribed. Why is milk sowing so widespread? Firstly, this is additional money, which is especially beneficial for commercial medical organizations. Secondly, not all doctors understand the physiology of lactation and understand that the quality of milk, in general, does not depend on the microorganisms found in it - most of them die in the child’s stomach. Thus, the presence of microbes in mother’s milk usually does not affect the health of a full-term mature baby.

Often mothers, and especially grandmothers, want to be sure that the milk the baby receives is “good”, “high quality”, sufficiently fatty, high in calories, etc. Of course, it has long been known that Human milk is the optimal nutrition for infants and its composition is approximately constant. In order to determine the quality of milk, expensive specialized equipment is required, which no routine laboratory has. If you set out to check the “quality” of milk, this can only be done in a serious research institute. Besides, do we doubt the quality of other biological fluids in our body? They are what they should be under certain operating conditions. If there is a problem, certain symptoms, only then do we take tests - blood, urine, sputum, etc. The same goes for milk. Any mother's milk is suitable for her baby without serious health problems. There is no allergy to mother's milk - not a single specific immune response has been recorded in a breastfed child. Why do you suddenly want to check your milk? Usually these are problems with the amount of milk (real or apparent), insufficient or excessive weight gain of the child from someone’s point of view, fullness of the mother’s breasts, etc. The root of the solution to all these problems lies in establishing an optimal breastfeeding regimen, selecting the best position for feeding, teaching the baby to latch onto the breast correctly, but not in changing the composition of milk in an incomprehensible way. It has been proven that practically there is no connection between maternal nutrition and milk composition. A woman's milk can be anything in appearance - it is ideal for human babies.

Milk quantity is also a frequently worrying indicator for mothers. It is a big mistake to estimate the amount of milk by how much it is expressed. It is known that some women are unable to express milk at all, despite the normal growth and development of children receiving breast milk from the breast. We can reliably estimate the amount of milk only by the baby’s weight gain and discharge. If the baby is less than a month old, we expect at least one portion of stool every day. The urine of a well-fed baby who receives enough milk is almost transparent and has no distinct color or odor. Situations of low milk supply are common, but they are usually resolved by optimizing the breastfeeding regimen with the help of experienced breastfeeding mothers or a lactation consultant. In rare cases, a mother actually does not have 100% milk to feed her baby, but even then it is possible to help her in one way or another. A lack of milk does not mean that the child must immediately be completely transferred to artificial nutrition.

Should milk be analyzed? Apparently not.

Don't let incompetent professionals confuse you and make you lose confidence in your ability to feed your baby with your milk.

Currently, most mothers strive for full breastfeeding. After all, it is known that breast milk, fully provides the baby with all the nutritional components necessary for full growth (proteins, fats, carbohydrates, minerals and vitamins), because it contains them in the required quantities and correct proportions. In addition, mother's milk contains special biologically active substances, the so-called protective factors, supporting the immunity of the child's body. The baby's own mechanisms that prevent infectious diseases are immature, and colostrum and breast milk due to their composition, they protect the intestinal mucosa from inflammation, inhibiting the growth of pathogens, and also stimulate the maturation of intestinal cells and the production of their own immune defense factors. The highest concentration of protective factors is observed in colostrum; in mature milk it decreases, but at the same time the volume of milk increases, and, as a result, the child receives protection from many diseases constantly, throughout the entire period of breastfeeding. The longer breastfeeding, the more protected the baby is from disease. However, if the mother has an infectious disease, the question of whether to continue breastfeeding or not is decided together with the treating pediatrician. In case of acute purulent mastitis, breastfeeding is stopped (most often for the duration of antibiotic treatment, up to 7 days). For other forms of mastitis (not purulent), experts recommend continuing breastfeeding. This will quickly eliminate milk stagnation. Very often, to identify pathogens, sick nursing mothers are asked to take breast milk for an analysis that determines the microbiological sterility of milk, after which the issue of breastfeeding is decided. The study is carried out in bacteriological laboratories of the SES or medical institutions, information about which is available from the local pediatrician. How justified are such studies? According to the World Health Organization, Each pathogenic microbe that infects a nursing mother stimulates the production of special protective proteins - antibodies that enter the breast milk and protecting babies, both full-term and premature. Scientists have identified antibacterial and antiviral factors present in breast milk that can resist most infections. Researched breast milk and the feces of babies are milk consumers. It turned out that in most cases microorganisms found in milk are in feces baby are missing. This suggests that microbes that can cause diseases when they enter the baby’s intestines with milk most often do not take root there, which is facilitated by the protective properties of breast milk. Thus, even if some microorganisms are detected in the milk, but there are no signs of acute purulent mastitis, breastfeeding will be safe, because with milk the baby also receives protection from diseases. Moreover, in this case there is not even a need to have the milk tested for sterility. It’s just that in district clinics, when recommending this test, they often simply follow tradition.

Infection or normal?

Breast milk can contain not only pathogenic microbes, but also representatives of the normal microflora of the skin and mucous membranes - epidermal staphylococci and enterococci, which perform a protective function. The presence of representatives of normal microflora in the analysis only indicates that the milk for analysis was collected incorrectly. Therefore, if their number is higher than normal, it is impossible to draw any categorical conclusions. Pathogenic microbes include Staphylococcus aureus, hemolyzing Escherichia coli, Klebsiella, etc. The routes of transmission of infection are different. Firstly, dangerous microbes can get into milk during an infectious disease of the mother (for example, with sore throat), as well as during acute purulent mastitis. Secondly, during pumping and storage, when the breast pump or container is not clean enough. Fortunately, most often microorganisms from the normal flora of maternal skin get into expressed milk. Normally, 1 ml of milk can contain no more than 250 bacterial colonies (250 CFU/ml). This number is a kind of boundary between normal and dangerous conditions. If it is smaller, pathogenic microbes do not pose a danger to the baby. But with weakened immunity, for example, in very premature babies, a much smaller number of pathogens can be dangerous. The decision to continue breastfeeding in such cases is made depending on the condition baby. At the present stage of development of medicine, testing breast milk for sterility is no longer very relevant, because a doctor can diagnose “purulent mastitis” without analysis results. Yet in some cases milk testing is absolutely necessary. Bacteriological examination is mandatory:

• if a woman has had purulent mastitis;
• if baby During the first 2 months of life, persistent diarrhea (loose, dark green stool mixed with large amounts of mucus and blood) is observed, which is combined with low weight gain.

Leading neonatologists have long proven the benefits of mother's milk for a newborn. However, situations often arise when breastfeeding causes significant harm to the health of the baby.

The only solution is to test breast milk. Only by its results can one judge the possibility of using natural feeding or switching to artificial feeding.

When and why is breast milk analyzed?

It is believed that mother's milk contains all the nutrients and vitamins the baby needs and is not subject to heat treatment. However, there are often cases when representatives of pathogenic microflora penetrate into breast milk. Microorganisms reach the baby along with the nutrient fluid and begin to develop, thereby causing harm to the baby’s body.

If previously it was believed that mother’s milk was sterile and harmless, today medicine refutes this statement. The presence of opportunistic microorganisms (fungi, bacteria, microbes) is allowed in breast milk. But provided that they do not cause cause for concern, and their number does not exceed the norm. Often, problems arise due to the weakening of the mother's immunity during pregnancy and after childbirth. Also, poor maternal hygiene during feeding leads to the development of infant feeding problems.

Where can I submit it??

City clinics do not have the necessary equipment. Therefore, you can do a hemotest to study breast milk in the laboratory of private clinics. However, a referral from a pediatrician is not necessary.

When necessary do?

• constant digestive disorders, flatulence, colic in an infant;
• purulent discharge from the mother's nipples;
• the presence of a gag reflex in the child during feeding;
• unstable, as well as constant loose stools;
• the appearance of bloody inclusions in the baby’s stool;
• skin rashes, purulent formations (pyoderma) on the mucous membranes of the child;
• purulent or recurring mastitis in the mother.

There are several types of studies of this secretory fluid.

Testing breast milk for sterility allows you to determine the presence of pathogenic microorganisms. It can also be used to determine their sensitivity to antibacterial drugs and select the appropriate treatment.

The main representatives of dangerous microflora are:

• Candida fungi;
• enterobacteria;
• staphylococcus;
• coli.

Staphylococcus aureus in breast milk is the most dangerous representative of this bacterial family. Infection with it inevitably leads to complications of lactation, such as purulent inflammation and mastitis.

It is necessary to have breast milk tested for antibodies if the Rh factors of the mother and baby do not match. This study determines the presence of immunoglobulins in the mother and the possibility of them entering the child’s body.

How to properly collect milk for analysis?

To obtain the most reliable results, it is necessary to correctly submit milk for analysis. Dishes play an important role. To collect breast milk you need to take special sterile jars. You can sterilize them yourself or take them to the laboratory where the research will be carried out. Also, sterile tubes are sold in pharmacies.

Next, you need to disinfect your hands and, directly, your chest. If this is not done, microorganisms will enter sterile containers and the analysis will be unreliable. To avoid cracks and abrasions on the nipples, the breasts are washed with liquid soap and wiped with a napkin. Then the nipples and areolas are wiped with an alcohol solution. If these conditions are not met, a pathogenic infection may enter the research material.

Next, you need to express the milk, skipping the first few ml. Milk from the right and left breasts must be expressed into a separate jar, which must be signed. A sufficient amount of milk for analysis is 10 ml from each breast. Milk is only suitable for analysis for a few hours, so it cannot be stored for long periods of time. It is important to send it for analysis as quickly as possible. Waiting for results takes about a week.

Interpretation of breast milk analysis

If there are one or more negative symptoms, the mother herself should be interested in donating breast milk for analysis. In laboratory conditions, milk is inoculated onto a nutrient medium, on which bacteria begin to multiply. These bacterial colonies are then examined. It includes determining the type of pathogen, quantity, as well as immunity to antibiotics. For example, Staphylococcus aureus, getting on the mammary gland, can lead to purulent mastitis. Interpretation of the culture results is carried out exclusively by a doctor and he also prescribes the necessary treatment. Treatment is prescribed if the number of pathogenic microorganisms exceeds the norm (250 CFU/ml).

The first portion of milk contains less fat, so the fat content is assessed by the so-called “hind milk”. That is, expressed at the end of feeding. The percentage of fat content is taken as 1 ml of cream on the surface. The norm is 4 ml.

If antibodies are detected, the pediatrician may prohibit breastfeeding for up to one month. During this time, the baby's body will become stronger and it will be possible to return to breastfeeding.

What to do if the result is bad?

If your breast milk test results are poor, you need to focus on treatment and prevention. Treatment is prescribed by a doctor, but preventive measures can be used by mothers at home:

• do a circular breast massage to prevent the development of mastitis;
• be sure to maintain intimate hygiene after childbirth;
• follow a hypoallergenic diet in the first months after the birth of the baby;
• solve health problems in a timely manner.

At the first alarm bells, be sure to do a breast milk hemotest.

There is nothing more nutritious and beneficial for a baby than mother's milk. There is no product of this composition in nature. Unfortunately, during lactation, mothers sometimes suffer from infectious diseases. Does the infection get into women's milk? In order to detect disease-causing microorganisms in it and decide on the advisability of continuing breastfeeding, the doctor recommends that the woman have her breast milk tested.

The healthiest food for a baby is its mother's milk.

How sterile is human milk?

Contrary to popular belief about the sterility of human milk, recent research by scientists has proven that the presence of some microorganisms is quite natural and normal for this biological fluid.

In the body of any person live various representatives of opportunistic microbes, which do not make themselves felt and do not bother their carrier.

They begin to actively reproduce and provoke disease only under certain conditions, such as:

• improper or insufficient nutrition;
• decrease in the body’s overall resistance to infections due to serious illness;
• impaired intestinal absorption;
• weakening of the body due to heavy physical or mental labor;
• stressful situations, significant moral experiences.

What “insidious pests” do laboratory technicians most often find? Among them there are both almost harmless and dangerous enemies:

• coli;
• yeast-like fungi;
• enterococci;
• Staphylococcus epidermidis;
• Klebsiella;
• streptococcus;
• Staphylococcus aureus.

What is the harm from microbes from breast milk?

Infection with Staphylococcus aureus can cause a lot of suffering for both mother and her baby. This pest is armed with a microcapsule that helps it easily penetrate living tissues while maintaining its structure, as well as several types of poisons that destroy healthy cells.

Staphylococcus aureus, which enters the baby's stomach through breast milk, can cause the following diseases:

• purulent inflammation of the skin and mucous membranes, such as multiple furunculosis;
• respiratory tract diseases (sinusitis, pleurisy, tonsillitis);
• inflammation of the middle and inner ear (otitis);
• digestive dysfunction (stomach pain, flatulence, frequent diarrhea, repeated vomiting).

In a nursing woman, a staphylococcal infection that has entered the mammary gland can cause purulent mastitis. With this disease, breastfeeding is absolutely impossible, and the child has to be transferred to artificial feeding.

You should know that staphylococcus living in breast milk is highly resistant to various types of external influences and is destroyed only by certain antibacterial drugs. To completely get rid of it, you need to stock up on considerable patience and perseverance.

Infection through milk with Klebsiella, yeast-like fungi or E. coli will also not bring pleasure to the baby. As a result of their fermentation of lactose, gas is released in large quantities, causing the baby to suffer from frequent loose stools and bloating.

How does the infection enter milk?

Typically, pathogenic bacteria enter the ducts of the mammary gland, and then into the milk, through cracks in the epidermis of the nipples. Cracks appear when:

• they remove the breast from the baby’s mouth with too sudden a movement;
• the mother feeds the baby in an awkward position;
• the mother allows the baby to nurse for a long time after he has had enough;
• the nipples were not prepared for feeding the baby during pregnancy.

A detailed microbiological analysis of breast milk is useful not only because it can show the presence or absence of pathogens, but also because it makes it possible to determine for the identified microorganisms their resistance to certain antibiotics. All breastfeeding mothers, without exception, do not necessarily need to test breast milk for sterility. The doctor refers only those women who suspect mastitis and whose children suffer from gastrointestinal disorders or skin diseases for analysis of the sterility of breast milk.

If you have hyperemia and swelling of the gland, high temperature - these are sure signs of mastitis. Most likely, the test will find staphylococcus in her.

A woman should be wary and have her breast milk tested for staphylococcus if her baby has incessant diarrhea with greens and mucus, or uncontrollable vomiting. Or his skin is completely covered with pustules.

How to properly collect milk for analysis?

To collect milk for analysis, follow these recommendations:

1. Prepare two glass or plastic disposable jars for analyzing breast milk - there should be separate containers for the left and right breasts.
2. Boil glass jars with lids for 10 - 12 minutes; just wash plastic ones with warm water.
3. Make a mark on each container for the left and right breast.
4. Wash your hands and breasts with warm water and baby soap.
5. The first milk supply is not suitable for culture, so first express 10 ml from each breast into the sink and rinse the breasts again.
6. Dry your breasts with a clean cloth.
7. After this, express 10–15 ml from each gland into prepared jars and close them with lids.
8. Very quickly deliver or take the jars of milk to the laboratory. Breast milk analysis should be done no later than 3 hours from the moment of expression.

A woman needs to be extremely careful when collecting milk for sowing. Bacteria from skin or clothing should not enter it.

In the laboratory, milk samples are sown on nutrient soil, where microorganisms grow rapidly. Simultaneously with determining the type and number of bacteria, their resistance to antibiotics is determined.

What could be the result of the analysis?

The test result is usually ready within a week. With this result, the woman goes to the doctor, who, if necessary, prescribes her a course of treatment.

Options for the development of events:

1. Culture did not reveal the growth of microorganisms, that is, there are practically signs of sterility of breast milk. This is a rare case of result.
2. The growth of epidermal staphylococcus or enterococcus in small quantities was detected. This result is the most common and indicates that there is no danger to the health of the mother and child, since these representatives of the microflora can exist in a healthy human body. You can safely continue breastfeeding.
3. A nursing mother needs serious treatment if Staphylococcus aureus, yeast-like fungi or Klebsiella are found in breast milk.

A little about treatment

Evgeny Komarovsky in his videos says that if staphylococcus is detected in breast milk, but the woman has no symptoms of mastitis, then there is no need to stop breastfeeding. In this case, the woman is prescribed treatment with antiseptic drugs, which are not prohibited during lactation, and the baby is prescribed a course of lacto- and bifidobacteria to prevent digestive disorders.

If the mother has all the signs of purulent mastitis caused by a staphylococcal infection, breastfeeding should be stopped until the mother has completely recovered.

Milk still needs to be expressed regularly so that it does not go to waste, as well as to prevent complications. For mastitis, antibiotic therapy is prescribed. If the baby managed to become infected with staphylococcus from his mother, then he is also given appropriate treatment.