Recommendations for reconstituting powdered infant formula have changed, to  
decrease the risk of Enterobacter sakazakii contamination in an infant's 
bottle.  The water is supposed to be boiled and then cooled to a temperature of 
70-90  degrees C (158-194 degrees F) and then added to the formula. The organism 
is  heat tolerant so the hotter water is supposed to render the bacteria 
harmless.  However, E sakazakii is a coliform bacteria with Codex standards 
allowing 1-10  coliform bacteria per gram of formula. Salmonella and Listeria are at 
zero  tolerance in powdered formula, but E sakazakii specifications do not yet 
exist  for powdered formula. I think there are 5 or 6 lawsuits in the US 
regarding  infant illness from powdered formula. One of these suits was from 
powdered  formula given out in a corporate gift bag. The contaminated formula in 
the gift  bag gave the baby meningitis. What a welcome to the world present.
 
The European Food Safety Authority has recommended that no infant under the  
age of 4 weeks receive powdered infant formula. The FDA has notified NICUs not 
 to use powdered infant formula with preterm infants. NABA has information on 
 this problem at its website at _www.naba-breastfeeding.org_ 
(http://www.naba-breastfeeding.org)  under  News and Alerts. I am always intrigued that 
hospital risk management departments  do not ban the practice of distributing 
commercial gift bags due to the hazards  of the formula contained in them. The 
hospital does not record the lot or batch  numbers on each can and is unable to 
contact mothers who receive formula that is  later recalled.
 
Marsha Walker, RN, IBCLC
Weston, MA

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