AH an ongoing frustration, this PIF preparation issue...
This is from the FDA website: " Safety  Issues
    *   Formula preparation. In most cases, it's safe to mix formula using  
ordinary cold tap water that's brought to a boil and then boiled for one  
minute and cooled. According to the World Health Organization, recent studies 
 suggest that mixing powdered formula with water at a temperature of at 
least  70 degree C—158 degrees F—creates a high probability that the formula 
will not  contain the bacterium Enterobacter sakazakii—a rare cause of  
bloodstream and central nervous system infections. Remember that formula made  
with hot water needs to be cooled quickly to body temperature—about 98 degrees 
 F—if it is being fed to the baby immediately. If the formula is not being 
fed  immediately, refrigerate it right away and keep refrigerated until  
feeding.   " 
    *   _http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048694.htm_ 
(http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048694.htm)  
    *   I can't get my machine to stop with the bulleting, but it's me, 
Judy,  here...doesn't this read like the probability of the ES being there is  
actually created/caused by the use of 70C/158F water, not that PIF  might 
already contain it and that is why these prep steps are being  suggested?  I 
know, now that I've read it again, that there is a NOT in  there, but it 
reads awfully poorly in my opinion. It also doesn't actually  recommend it, or 
say that the AAP recommends it, just that WHO talks about it.  It just 
suggests that if you are going to follow WHO you also have to take  this extra 
step. It makes it sound sort of arbitrary and unneeded because it's  "rare". 
They should have said "rare but life-threatening" or something. That  idea and 
wording won't carry much clout in the USA, and even most  pediatricians 
often go against their own AAP recommendations on various issues  ( room 
sharing, exclusive breastfeeding, no extinction sleep training, etc.)  so parents 
receive no support to follow them except from the annoying of us  who know 
the reccs and actually bring them up and support them.
When you google AAP,  Safe Formula Prep, this is one AAP thing  that pops 
up: 
"  
Preparing infant formula
Water used for mixing infant formula must be from a safe source. Your  
local health department can help you determine if your tap water is safe to use  
for your baby’s bottles.  
If your tap water is safe, simply mix powdered formula with room  
temperature tap water, and the bottle is ready to use." from 2010, so even if  they 
did redo their recommendation, parents are going to get this from fairly  
recently. _http://aapnews.aappublications.org/content/31/10/37.5.full_ 
(http://aapnews.aappublications.org/content/31/10/37.5.full)  
When moms are in hospital, or being discharged home with babies that are  
being supplemented with formula, do moms get this information or are  
hospital-based professionals not supported in sharing it either. If I bring it  up, 
it's the first time parents have heard it. Now this is different than 
adding  PIF to mom's own expressed milk, but many moms might need this 
information  clarified in addition I would think. 
Thoughts? 
Peace,
Judy 

Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA
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