CDC alerts after death from bacteria in breast pump – 03/13/2023 – Equilíbrio

The US Centers for Disease Control and Prevention (CDC) issued a report reminding parents and caregivers of infants to thoroughly clean and sanitize breast pump equipment following the death of an infant in 2022 from a rare bacterial infection linked to a contaminated sucker.

The child, who was born prematurely, was infected with the bacteria cronobacter sakazakiia microorganism that can cause fatal meningitis and sepsis in young babies, and which triggered a recall of infant formula across the US in 2022.

At the time of her illness, the baby was being cared for in the neonatal intensive care unit, although she was stable and growing well on a combination of pumped breast milk and liquid human milk fortifier (which adds nutrients).

Evidence of the bacteria was found on parts of the breast pump that was being used in the family’s home. They were washed in a domestic sink, sanitized and sometimes reassembled while still damp.

Here’s what we know about bacteria and what parents and caregivers should know about cleaning equipment parts between uses.

What is the bacteria about?

Cronobacter sakazakii is a strain of wronobacter, a germ that can live in the environment or in dry food. Infections in babies younger than 12 months of age are often associated with powdered infant formula, which, unlike liquid formula, is not sterile.

The formula can be contaminated with the bacteria during on-site product processing, where it can get in through the soles of shoes or people’s hands, or it can happen at home.

In these cases, contamination can occur if container lids or ladles are placed on contaminated surfaces such as counters or sinks, if the formula is mixed with contaminated water or in a contaminated bottle. Improper hand washing before preparing formula can also lead to infection.

The new CDC report includes a case where a baby born on the correct period was infected with the bacteria from an opened can of powdered infant formula. The child was hospitalized and made a full recovery.

What is the risk for babies?

although acronobacter sakazakii is harmless to most children, babies younger than 2 months, those born prematurely or with weakened immune systems are more likely to develop serious complications if infected, including sepsis (a dangerous blood infection) and meningitis.

“The younger you are or the earlier you are born, the less mature your immune system is,” says Ann Kellams, a pediatrician at UVA Health in Charlottesville, Va., and president of the Academy of Breastfeeding Medicine. “An exposure of a 12-month-old baby versus a 2-week-old baby is potentially different.”

The CDC estimates that there are about 18 cases of infection with the bacteria in its invasive form (meaning it has progressed to a bloodstream infection or meningitis) each year in the United States, most of which stem from isolated cases of products and contaminated infant feeding equipment at home. For context, more than 3.6 million babies were born in the U.S. in 2021.

“Infections byronobacter are rare and should not discourage or frighten parents about feeding their babies,” says Hailey Nelson, a complex care pediatrician and lactation consultant at Valley Children’s Healthcare in Madera, Calif.

How can parents and caregivers avoid contamination?

Such as cronobacter sakazakii is widespread in the environment, it’s important for health professionals to educate parents of babies in the highest-risk categories about the bacteria, says the CDC, particularly if babies are fed formula, pumped breast milk, or a combination of the two .

When using powdered formula, the CDC recommends that caregivers wash their hands thoroughly before preparing bottles and clean and sanitize the area where they are going to bottle feed. It is important to clean and disinfect the bottles in advance and use water from a safe source. Keep formula cap and shell clean and dry and close container immediately after use.

As for the pumps, hospitals caring for babies born prematurely or in critical condition must give parents specific instructions to avoid contamination and, when they are discharged, send them home with a “dedicated basin” for cleaning supplies, he points out. the report. In fact, the CDC cautions all parents against placing pump parts directly in the sink, as this can increase the risk of contamination.

But the agency isn’t calling for any changes to its best practices for cleaning pump parts. The CDC says it can be done by hand or in the dishwasher if the pump kit manufacturer recommends it.

“Families should always disassemble the pump parts before washing them,” points out Meghan Devine, registered nurse, lactation consultant and clinical supervisor for the Lactation Program at Children’s Hospital of Philadelphia. “They should wash the pump parts in hot soapy water and rinse well between each pumping session. Families should also sanitize the pump parts once a day by boiling the parts, using a microwave disinfectant bag or using the ‘disinfectant’ setting on the dishwasher.”

CDC guidelines provide more detail — they note, for example, that pump parts must be completely air-dried if they are hand-washed (not with a dish towel). And that caregivers should wash their hands before removing clean pump parts from the dishwasher.

While some parents quickly clean pump parts and store them in the fridge between pumping sessions when they’re in a rush, the agency notes that no studies have shown whether this effectively limits bacterial growth.

Many clinicians recognize that the process of expressing milk and cleaning pump parts is time-consuming and costly, and can be particularly difficult for women who have little time to express milk (because they are at work, for example) or because they are exclusively pumping. and need to repeat the process every few hours.

“We have to help moms find realistic strategies to keep their equipment as clean as possible, but also be able to practically stay on top of the pumping schedule,” says Lisa Hammer, pediatrician and lactation consultant at Trinity Health IHA Medical Group in Michigan. She often advises her patients to get a second set of pump parts if possible, and has noted that some insurers cover the cost.

Doctors interviewed for this story sought to reassure parents that, despite the severity of the new CDC report, these types of bacterial infections are rare and that the benefits of breast milk far outweigh the risks of infection.

“This is an unusual and very tragic situation, of course, but as mothers in our society, where we no longer have the village, we are gripped by the feeling that we need to be with our babies all the time and that we need to pump our milk when not. we’re with them,” says Kellams. “We’re all doing the best we can.”

Translated by Luiz Roberto M. Gonçalves