In Reply.—

We appreciate the comment and suggestion by Ng et al, who believe that, as a Chinese society, Taiwan might share a similar cultural belief that accounted for the high bacterial colonization rate as Hong Kong. This was the rationale to analyze the proportion of expressed breast milk (EBM) feeding versus banked breast milk feeding as the second confounding factor in our study.

EBM may be an underrecognized source of sepsis in susceptible infants. Human milk is a good culture medium and can be contaminated with many pathogens including Serratia marcescens group B streptococcus, methicillin-resistant Staphylococcus aureus,Escherichia coli, and other microorganisms that have been shown to result in sepsis. Contamination with >1000 Gram-negative bacilli per mL is associated with feeding intolerance, whereas higher levels of contamination (>1 000 000/mL) can be associated with sepsis.

We recognized in their report...

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