Pathogen Contamination of Infant Feeding Implements in High-Income Countries: A Systematic Review Restricted; Files Only
Rives, Abigail (Spring 2024)
Published
Abstract
When not consumed directly from the breast, an infant’s intake of milk can be an exposure pathway for dangerous pathogens to the baby as there is potential risk for contamination in infant feeding implements. The goal of this systematic review is to explore the existing research on what types of infant feeding implements have been examined for potential pathogen contamination, what types of pathogens have been found, what regions across the world this type of contamination is most prevalent in, and the types of settings (urban, rural, low socioeconomic status, high socioeconomic status, etc.) where pathogen contamination has been reported among infant feeding implements. We searched multiple databases including PubMed, CINAHL, Web of Science, CABI Global Health, and EMBASE. Title/abstract screening, full-text screening, and data extraction identified 21 studies for inclusion, of which 8 were conducted in a high-income country (HIC) setting. The following pathogens had a 100% detection rate: Escherichia coli, Serratia marcescens, Enterobacteriaceae, Staphylococcus epidermidis, Streptococcus faecalis, Pseudomonas aeruginosa, and Klebsiella spp. Acinetobacter spp. was the only pathogen tested for and not recovered from any implement. Of the four included studies that tested for pathogen contamination in breast pumps, all four detected pathogens. For breast pumps, the majority of detected contamination was found in the inner tubing. 75% of the studies which tested for contamination in infant feeding bottles detected pathogens. Three independent studies found that both bottles and breast pumps sterilized using a hypochlorite solution, rather than with just soap and boiling water, were more likely to be found within the “satisfactory” levels (i.e. less than five colonies per ml. of rinse). The limited data presented from the studies in this review demonstrate that there is a concerning risk of feeding implement contamination within a high-income country setting. However, this review has also identified a need for more current research into contamination of modern breast pumps and feeding implements, as many of the included studies were more than 30 years old.
Table of Contents
CHAPTER 1: INTRODUCTION... 1
Figure 1: conceptual framework... 1
CHAPTER 2: LITERATURE REVIEW... 2
2.1: Infant Feeding in the First Six Months of Life... 2
2.2: Bottle Feeding and Formula Preparation... 3
2.3: Risk of Pathogen Contamination... 4
CHAPTER 3: METHODS... 5
3.1: Data Management... 5
Figure 2. Key Word Search Terms and MeSH Terms by database... 9
3.2: Eligibility Criteria... 9
Figure 3. Full Text Criteria Flow Diagram for Inclusion... 10
Figure 4. PRISMA diagram showing screening and selection process for eligible articles... 11
3.3: Data Extraction... 12
CHAPTER 4: RESULTS... 12
4.1: Study Characteristics... 12
4.2: Pathogens Detected... 12
4.3: Breast Pump Contamination... 13
4.4: Bottle Contamination... 13
4.5: Other Components (Storage and Cleaning Equipment) Contamination... 13
Table 1: Overview of Study Characteristics among studies conducted in HIC to be included in systematic review on pathogen contamination of infant feeding implements... 14
Figure 5: Heat map showing number of studies testing and detecting pathogens in infant feeding implements... 16
CHAPTER 5: DISCUSSION... 17
5.1: Dangers in Bacterial Contamination... 17
5.2: Contamination of Breast Pumps... 17
5.3: Contamination of Infant Feeding Bottles... 18
5.4: Strengths and Limitations... 19
5.5: Implications... 19
CHAPTER 6: CONCLUSION... 20
REFERENCES... 21
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File download under embargo until 20 May 2026 | 2024-04-25 10:54:10 -0400 | File download under embargo until 20 May 2026 |
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