It might be helpful for health professionals to be made aware of the research around bacterial contamination of bottles and formula and rates of hospitalisation for infection in formula fed infants before they are told about bottle preparation. There is quite a bit of research showing how filthy "cleaned" bottles often are....we really have no idea how much of the 3-5X greater incidence of hospitalisation of formula fed infants is due to factors inherent to the formula itself and how much is a result of poor hygiene. There is some discussion of these issues in the paper Nina Berry and I wrote about emergency preparedness in developed countries. 
Karleen Gribble
Australia


On 20/05/2012, at 5:01 AM, Michelle Kinne wrote:

> I facilitate staff education intended to satisfy the criteria for educating staff in organizations seeking Baby Friendly Hospital Initiative accreditation in the US.
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> I too share the same experiences others have described when teaching about safe formula preparation. It is not uncommon for the *entire* room of sometimes as many as 50+ students whom are primarily RNs and occasionally physicians to express how incredulous they find the preparation recommendations, and sometimes even disbelief that they are necessary.
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> Compounding my dilemma regarding recommendations surrounding heating water are recommendations such as this provided by the American Academy of Pediatrics which states:
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> "If your tap water is safe, simply mix powdered formula with room temperature tap water, and the bottle is ready to use."
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> http://aapnews.aappublications.org/content/31/10/37.5.full.pdf
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> And this:
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> "How do I prepare my baby's bottles?
> Prepare your baby's formula by mixing water and the appropriate amount of powdered infant formula. The packaging on the side of the formula container will tell you how much to use. Carefully follow the directions. You can use tepid (room temperature) tap water, as long as your local or state health departments have labeled it as safe to drink.
> If you're concerned about your water, you may sterilize it to kill germs."
> http://kidshealth.org/parent/pregnancy_newborn/formulafeed/formulafeed_storing.html
> And then the WHO recommendations of course and the US FDA which states this:
> 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.  
> It doesn't appear to me that the AAP is recognizing the inherent risks of bacteria in the PIF, and that water boiling and reconstitution following cooling to no less than 158 degrees is to kill potential bacteria contaminants in the PIF, and *not* necessarily to address risky water sources.
> Anyone have other resources from the AAP that demonstrate otherwise?
> Michelle H. Kinne BA IBCLC RLC ICCE CD(DONA)
> www.CascadePerinatalServices.com
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