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ایمنی و سلامت شیر مادر اهدایی
بررسی ایمنی میکروبی شیر مادر اهدایی پیش از پاستوریزاسیون؛ نقش عوامل فصلی، مادری و فرایندی
پژوهشگران مرکز تحقیقات مادر، جنین و نوزاد پژوهشکده سلامت خانواده دانشگاه علوم پزشکی تهران، با بررسی ۵۰۹ نمونه شیر مادر اهدایی طی سال‌های ۲۰۱۹ تا ۲۰۲۵، الگوهای آلودگی میکروبی و عوامل مرتبط با آن را بررسی کردند. یافته‌ها نشان داد پس از پاستوریزاسیون، تمامی ۳۰۲ نمونه مورد بررسی از نظر عوامل بیماری‌زا منفی بودند و بهبود روش‌های کشت و اقدامات بهداشتی با کاهش میزان دورریز و تغییر الگوهای آلودگی همراه بوده است.
This repeated cross-sectional study evaluated microbial contamination in donor human milk over six years at the Human Milk Bank of Valiasr Hospital in Tehran. Among 509 samples screened, 207 were excluded because of microbial contamination, while all 302 pasteurized samples tested pathogen-free. Maternal, procedural, and seasonal factors were examined to identify pathogen-specific contamination patterns.
Donor human milk (DHM) is a vital alternative for preterm infants when maternal breastfeeding is unavailable, yet its microbial safety remains a critical concern. This study provides the first longitudinal evaluation of DHM contamination patterns in Iran, aiming to identify maternal, procedural, and seasonal risk factors to inform safer milk bank practices.
This repeated cross-sectional study evaluated microbial contamination in DHM over six years (2019–2025) at Valiasr Hospital’s Human Milk Bank (HMB) in Tehran. Samples were stratified into two phases following a protocol revision in October 2023, which introduced agar-based culturing and enhanced hygiene practices. Maternal, environmental, and seasonal variables were recorded for each donation. Pathogen-specific contamination rates were analyzed, and multivariate logistic regression identified independent predictors. Firth’s penalized likelihood method was applied to ensure statistical stability in sparse data models.
Of 509 DHM samples screened, 40.7% were excluded due to microbial contamination, while all 302 pasteurized samples tested pathogen-free. The transition to agar-based culturing and upgraded hygiene protocols in Phase II reduced discard rates and seasonal variation, with Staphylococcus epidermidis dropping from 21.3% to 3.2%. Klebsiella pneumoniae emerged as the dominant pathogen in Phase II (17.6%), with seasonal peaks in cooler months. Multivariate regression analysis identified manual expression as a significant predictor of Bacillus cereus contamination. For Staphylococcus epidermidis, longer intervals between childbirth and donation, as well as home refrigeration versus freezing, were independently associated with increased contamination risk. No significant associations were found for Klebsiella pneumoniae, Staphylococcus aureus, or Escherichia coli, suggesting pathogen-specific risk dynamics.
This study establishes a foundational microbiological profile of donor human milk in Iran and demonstrates that rigorous pasteurization protocols can ensure pathogen-free milk for NICU use. The integration of maternal, procedural, and seasonal variables identified important contamination drivers and highlighted the influence of methodological improvements on microbial detection. These findings support refinement of exclusion thresholds and culture techniques to balance milk safety with availability.
Among 509 donor milk samples, 207 (40.7%) were excluded for microbial contamination, while no detectable pathogens were found in the 302 pasteurized samples. Contamination patterns varied between study phases, with organism-specific associations involving milk expression, storage method, donation timing, and season. These observational findings do not establish causality or zero risk.1. Maternal-Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
2. Breastfeeding Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
3. Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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