text: CLOSE More women are buying breat milk online, but a study by Nationwide Children's Hospital discovered high levels of bacteria. Courtesy Nationwide Children's Hospital Nationwide Children's Hospital 
   
   Researchers find high levels of bacteria that can make infants sick in breast milk purchased via the Internet. 
   
   Despite safety concerns, new mothers are increasingly buying and selling milk over the Internet. A recent study by researchers at Nationwide Children's Hospital found that 75% of the breast milk they bought online was contaminated with high levels of bacteria. (Photo: Nationwide Children's Hospital) Story Highlights The selling of breast milk to others over the Web has become a growing trend 
   
   Researchers found high counts of harmful bacteria and even fecal contamination in the milk 
   
   The findings were likely the result of poor collection, storage or shipping practices 
   
   Thanks to the Internet, women who produce an abundant supply of breast milk and those in need of it for their babies have more opportunities than ever to connect. But a first-of-its-kind study finds high levels of harmful bacteria and contamination in breast milk purchased via the Web. 
   
   Researchers' analysis of 100 samples of breast milk bought on a public milk-sharing website found three in four samples contained either high levels of bacterial growth overall or contained disease-causing bacteria, including fecal contamination. 
   
   The findings were likely the result of poor hygiene during milk collection, the use of either unclean containers or unsanitary breast milk pump parts, or compromised shipping practices, says epidemiologist Sarah Keim, lead author of the study in November's Pediatrics, published online today. 
   
   Nineteen percent of sellers did not include dry ice or another cooling method when shipping, according to the study. 
   
   It is unknown exactly how common purchasing breast milk online is, but a soon-to-be published journal article by Keim found 13,000 postings on U.S. milk sharing websites in 2011. 
   
   It is "totally normal" for there to be certain bacteria in human breast milk, says Keim, a principal investigator with the Center for Biobehavioral Health at Nationwide Children's Hospital in Columbus, Ohio. Some are "very important and healthy for babies and the development of their immune system and digestive system," she says. 
   
   This study focused on bacteria which "are generally pretty harmless as long as they don't grow out of control" but have also been associated with illnesses in infants linked to contaminated milk, including staphylococcus and streptococcus, says Keim. It also focused on bacteria associated with disease even at low levels, such as salmonella and E. coli. 
   
   Researchers compared the online-purchased breast milk samples to samples of unpasteurized breast milk donated to a non-profit milk bank. 
   
   Twelve such banks throughout the U.S. follow strict guidelines set by the Human Milk Banking Association of North America and provide pasteurized milk from carefully screened donors to fragile and premature infants, primarily in hospitals. Pasteurization kills the harmful bacteria before the milk reaches an infant. 
   
   In all the samples analyzed, the Web-purchased milk had higher bacteria counts and were more likely to contain disease-related types of bacteria, even though the donated milk from the milk banks had yet to be pasteurized: 
   
   -- 72% had any detectable gram-negative bacteria, which are associated with bloodstream infections, wound or surgical site infections, meningitis and fecal contamination vs. 35% of milk bank samples 
   
   -- 63% tested positive for staphylococcus vs. 25% of milk bank samples 
   
   -- 36% tested positive for streptococcus vs. 20% of milk bank samples 
   
   -- 3% were contaminated with salmonella vs. none of the milk bank samples. 
   
   All of the samples tested negative for HIV, says Keim, but the laboratory analysis to determine "the authenticity" of the breast milk is just beginning, she says, adding: "We're a little suspicious of some of the milk." 
   
   "This study confirms what people have suspected in terms of online milk purchases," says Anne Eglash, a family medicine physician with University of Wisconsin Health in Mt. Horeb and a co-founder of the Academy of Breastfeeding Medicine. She was not involved in the new study. 
   
   "You don't know what you're getting, you don't know the quality, how honest people are about how old the milk is, and so many other issues. It's important to realize that this may not be the safest way to get breast milk when you don't have enough," she says. 
   
   But Eglash, co-medical director of the still-in-development Mother's Milk Bank of the Western Great Lakes, cautions against "throwing the baby out with the bathwater" when it comes to the sharing of raw, unpasteurized human breast milk between lactating women and those who cannot, for medical or other reasons, provide their own milk for their healthy, full-term babies. 
   
   "I don't think the message should be that women should never share milk, but that this behavior of buying it on the Web from someone you don't know should not happen," she says. Eglash emphasizes that "you don't want unpasteurized milk that has various bacteria going to an infant whose immune system is vulnerable," but says there are safe ways to share human breast milk with healthy infants who are not your own, as well as pasteurize it at home. 
   
   The Food and Drug Administration warns against feeding babies breast milk acquired directly from individuals or through the Internet, citing safety concerns; the American Academy of Pediatrics discourages feeding preterm infants human breast milk from unscreened donors. 
   
   Keim, author of the new study, says her findings "may not apply to situations where milk is shared among friends or relatives or donated rather than sold. The potential risks of those situations are less well understood." 
   
   Read or Share this story: http://usat.ly/1gwTueV ||||| “We worried at first,” she said. “We wanted to be mindful that the donors were healthy, but there was never a moment when we were afraid. We’ve had the milk of about 30 women and have never had a problem.” 
   
   Women who do not wish to rely on an informal network may turn to breast milk banks, which store and sell breast milk from donors. Thirteen banks in the United States and Canada follow voluntary guidelines set up by the Human Milk Banking Association of North America, which require that donors and donations be screened, and that milk be pasteurized. 
   
   But milk banks give priority to premature infants with significant medical complications, and the milk is available only by prescription. A bank will supply milk by prescription to healthy infants, but only if sufficient supplies are available — and they rarely are. The association’s banks distributed 2.15 million ounces in 2011, but the current annual need is 9 million ounces. 
   
   Even when it is available, milk from banks is expensive, as much as $6 an ounce, and the average intake of a 1-month-old is about 25 ounces a day. 
   
   All of this encourages new parents, often scrambling to find breast milk on short notice, to shop for cheaper or more convenient sources, and Web sites including onlythebreast.com and eatsonfeets.org have sprung up to fill the demand. In 2011, there were more than 13,000 postings on the four leading milk-sharing Web sites, according to Sarah Keim, an assistant professor of pediatrics at Ohio State and a researcher at Nationwide Children’s Hospital in Columbus, Ohio. 
   
   Photo 
   
   In using any of these services, the buyer relies on the representations of the seller. The new study suggests that may prove hazardous. 
   
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   Dr. Keim and her colleagues collected 101 samples from milk-sharing Web sites, recording the sellers’ assertions about their own health and their methods of handling and storage. Then the researchers analyzed the bacterial content in the samples, comparing them with unpasteurized breast milk from screened donors at banks. 
   
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   The researchers found that 64 percent of the samples from milk-sharing sites were contaminated with staph, 36 percent with strep, and almost three-quarters with other bacterial species. Three of the samples contained salmonella. Seventy-four percent of the samples would have failed milk bank criteria. 
   
   The unpasteurized milk bank samples were not entirely free of contamination either, but they were considerably cleaner than those from the online milk-sharers — 25 percent were contaminated with staph, 20 percent with strep, and 35 percent with other types of bacteria. Twenty-five percent of the milk bank samples contained no detectable bacteria at all, compared with 9 percent of the samples from milk-sharing sites. 
   
   “Most staph and strep are harmless at normal levels,” Dr. Keim said. “But some of the levels we found were very high.” Nine percent of the milk-sharing samples contained dangerous levels of staph, and a handful had unusually high strep levels. Salmonella “doesn’t belong in milk at all,” she said. 
   
   Dr. Keim gave high marks to the milk banks. “When you donate to one of the H.M.B.A.N.A. banks, you know it’s been processed and made safe for a baby who really needs it.” 
   
   All milk shipped from milk banks is pasteurized, which kills skin and gastrointestinal bacteria, as well as many viruses, including those that cause colds. But pasteurization also destroys some of the beneficial substances in breast milk. 
   
   Kim Updegrove, president of the milk bank association, believes that however well intended, informal sharing of breast milk can be hazardous. 
   
   “If you get milk from an unscreened sharer, you put your child at risk,” she said. “I hate to say this to an informal sharer, because they are trying to do good. But they are playing a game of Russian roulette.” 
   
   The Food and Drug Administration does not regulate the buying or selling of breast milk, but the agency discourages both online and person-to-person sharing. Only three states — California, Maryland and New York — regulate milk banks. New York, for instance, specifies rules for collection and storage of breast milk, and requires that donors be screened and periodically re-evaluated in a process overseen by a physician. 
   
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   Dr. Keim said there is no way for a consumer to be certain what she is getting from an online source. 
   
   “We looked at everything a buyer could know herself — temperature, the condition of the containers, how long it took to ship, what sellers were saying in their ads — and only the time in transit had any effect on contamination. 
   
   “Buyers have no way of knowing even what they’re getting — it could be cow’s milk or formula.” ||||| Informal sharing of human milk has been gaining popularity in the U.S., spurred by research suggesting breast-fed babies are healthier than those fed formula. But a study being published Monday in the journal Pediatrics found that 72% of breast-milk samples purchased over the Internet contained infection-causing bacteria and 21% had potentially harmful viruses. 
   
   As news of the forthcoming study spread, one milk-selling site,...
target: – With the rise of sharing breast milk, a disturbing new study finds that 72% of samples bought online contained bacteria that could cause infections and 21% contained viruses. In 74% of the 101 samples purchased anonymously from two popular websites, the total bacteria count was significantly higher than the level generally considered safe. Bacteria found included E. coli, staphylococcus, streptococcus, and even salmonella, the Wall Street Journal reports. The FDA does not regulate the breast milk market, though it discourages sharing, the New York Times reports. Breast milk can be sold or donated on dozens of websites, and while some suppliers hand off the milk in person, others ship it. Problems during collection (improper hand-washing, dirty breast pumps or containers), improper storage (19% of the samples in the study were not cooled), and long shipping times (some of the samples took as long as six days to arrive) likely contributed to the health hazards. Another potential problem: Researchers say they are "a little suspicious of some of the milk," and are now working to determine if it's authentic breast milk, USA Today reports. In response to the study, at least one site that sells milk will stop allowing mothers to purchase from other mothers; donors will instead sell to a company that processes breast milk.