The bacteriological screening of donated human milk: laboratory experience of British Paediatric Association's published guidelines.

This study was undertaken to assess the application of the British Paediatric Association's (BPA) published guidelines to the bacteriological screening of breast milk donated to a District General Hospital milk bank. Samples of donated milk were subjected to bacterial counts and provisional identification after both 24 and 48 h incubation on cysteine lactose electrolyte-deficient (CLED) and Columbia blood agar. 21.8% (76 out of 348) donations of milk failed to reach the BPA acceptable criteria. The organisms responsible for the rejection of these samples were all evident within 24 h incubation, and were not significantly confined to one medium. A large percentage of rejected samples originated from a small number of donor mothers; 63.2% came from one donor. In applying BPA guidelines, both CLED and Columbia blood agar were found to be equally effective in screening for unacceptable organisms in prepasteurization donated breast milk. The 24 h period allowed for bacteriological screening, prior to pasteurization of milk samples, was sufficient to allow the growth of all potentially pathogenic bacteria in this study. To prevent the donation of consistently contaminated milk, more active communication between the milk bank staff and the donor is recommended.

Evaluation of a new lithium dosage-prediction technique.

The accuracy of a lithium dosage prediction technique was studied retrospectively. The dosage-prediction technique evaluated is based on lithium body clearance. The medical records of 71 psychiatric patients (30 men, 41 women) were reviewed. Age, sex, height, weight, serum creatinine, and one-compartment intravenous dosage equations were used. The lithium dose that would produce steady-state concentrations equal to those actually attained clinically was calculated. Forty-five (64%) of the predictions were within one capsule/day of the actual dose. There were 42 episodes (59%) of underprediction and 10(14%) of overprediction by one or more capsules per day. Underprediction occurred significantly more often in women than in men (31/41 versus 11/30). Predictions differed from actual doses by three or more capsules per day in 10 cases, nine of which were underpredictions. These patients did not differ significantly from the rest of the study group in age, sex, weight, serum creatinine, creatinine clearance, concurrent medical problems, or other medications. This lithium dosage prediction technique may be reliable, rapid, and inexpensive, but further refinement and prospective evaluation are necessary.