title: 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.
authors.affiliation: 700 Children's Dr, Columbus, OH 43205. sarah.keim@nationwidechildrens.org.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Keim
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Hogan
authors.forename: Kelly A
authors.initials: KA
authors.lastname: McNamara
authors.forename: Vishnu
authors.initials: V
authors.lastname: Gudimetla
authors.forename: Chelsea E
authors.initials: CE
authors.lastname: Dillon
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Kwiek
authors.forename: Sheela R
authors.initials: SR
authors.lastname: Geraghty
mesh_terms: D015169:Colony Count, Microbial / Q000592:standards; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020407:Internet / Q000191:economics / Q000592:standards*; D017784:Milk Banks / Q000191:economics / Q000592:standards*; D008895:Milk, Human / Q000382:microbiology*; D012475:Salmonella / Q000302:isolation & purification; D013210:Staphylococcus / Q000302:isolation & purification
keywords: Internet; aerobic bacteria; breastfeeding; human milk; infant