Safe management of expressed breast milk: A systematic review

Background: Expressed breastmilk may be contaminated by viruses and bacteria, or lose nutritional value due to maternal transmission, storage, or handling. Babies may also unintentionally receive expressed breastmilk from a different mother.

Aims: Conduct a systematic review of evidence from countries with incomes comparable to Australia to summarise the evidence around safe management of expressed breastmilk in terms of the risks of pathogen transmission, contamination and nutritional degradation from storage and transport, disinfection and cleaning procedures, and procedures to minimise misdelivery risk.

Methods: A search of the international literature sought papers published from 2008 until November 2014. The reference lists of included papers were screened for additional studies. Included papers underwent methodological appraisal and data were extracted.

Findings: Few pathogens that cause significant morbidity and mortality in developed countries had clear evidence of transmission through breastmilk. Short term storage (up to 96h) at 6.8°C appeared to be safe. Frozen storage was generally safe but results in immunological component degradation. Expert consensus suggests that several acceptable methods of cleaning, including using warm soapy water, or boiling. Breastmilk management policies appear to reduce misdelivery of breastmilk.

Conclusion: While there is a generally low risk of pathogen transmission via breastmilk, benefits must be considered against potential disease severity. Short-term refrigeration is generally acceptable for storage and transport. Freezing is often safe but causes degradation of immunological components. Universally, equipment used for expression and storage of breast milk should be well washed and disinfected. Effective breastmilk management policies can reduce risks of misdelivery.