BABY WITH FORMULA
Powdered Infant Formula Can Harbor Rare but Deadly Cronobacter
By Will Boggs, MD
NEW YORK (Reuters Health)
Oct 08, 2012
Dr. Pinna says…
Although this infection is rare, the fact that the baby dies is sufficient for the
parents to change the formula.
Breast milk, without question is the most natural and ideal method of fading a baby.
If this is not possible, then a fresh liquid formula should be used.
Cost and convenience should not enter the picture.
ARTICLE FROM REUTERS
A new report warns that ready-to-feed infant formulas are safer than powdered formulas because the latter can be contaminated with Cronobacter, which can cause devastating or deadly infections.
Such infections are rare – but they can affect healthy full-term babies, according to the report, published online today in Pediatrics.
The average annual number of invasive Cronobacter infections worldwide increased from 1.5 in 1958-2003 to 4.3 in 2004-2010, according to the author of the report.
“Although the number of these infections each year is small, the outcomes are devastating and costly to parents, our society, and our economy,” Dr. Janine Jason from Jason and Jarvis Associates, Hilton Head Island, South Carolina told Reuters Health.
In 2002 and 2003, the World Health Organization, the U.S. Food and Drug Administration, and the American Academy of Pediatrics began cautioning doctors about the powdered formulas.
Reviewing 68 cases from around the world during 1958-2003 and another 30 from 2004-2010 – all in children without underlying disorders – Dr. Jason saw that 90% of infected infants had received powdered infant formula or human milk fortifier, and this proportion did not differ significantly between time periods. Cronobacter infection rarely occurred in exclusively breastfed infants.
Infections occurred in at least a dozen infants where FDA guidelines and label instructions were followed.
“Cronobacter has never been isolated from breast milk, unopened bottled water, treated US municipal drinking water, unopened ready-to-feed formula, or unopened concentrates,” Dr. Jason wrote in her paper.
Powered infant formula and human milk fortifiers “are not sterile,” Dr. Jason said.
“No matter what formula is used,” she added, “caretakers need to maintain appropriate formula preparation, feeding, and storage techniques (boil bottles et al. before use, prepare and store feedings away from other foods, wash counters and hands before preparation, discard uneaten formula after each feeding, and store opened liquid/mixed formula in a refrigerator, covered, for no more than 24 hours).”
Among the 96 cases identified (66 before the warnings, 30 after), only two infants were older than two months at symptom onset. Most infections occurred at home, although two infants became symptomatic at home on the day of postnatal discharge.
Dr. Jason said the two most important steps to prevent these infections are educating parents and healthcare providers, and advocating for changes in policy.
For instance, she would like to see the U.S. Department of Agriculture’s WIC (Women, Infants and Children) nutrition supplement program change its “primary contracts from powdered infant formula to ready-to-feed formula for infants in the first months of life.”
She would also “(encourage) formula companies to not increase ready-to-feed formula prices to profit by any change in recommendations; and encouraging employers to make breast milk pumping and storage feasible for working mothers.”
Dr. Dominique Turck from Universite Lille 2 in France told Reuters Health he agrees.
“Pediatricians and health professionals involved in child care should be informed that powdered infant formulas are not sterile and that there is a risk (that seems to be very low) of Cronobacter infection related to their use,” he said in an email. “Parents should receive clear instructions from health professionals on the preparation and storage of PIF.”
Dr. Turck added, “The ESPGHAN (European Society for Pediatric Gastroenterology, Hepatology, and Nutrition) Committee on Nutrition disagrees with the WHO recommendation of using boiled water to prepare powdered infant formula, not only because of possible adverse effects on nutrients but also of the risk of burns for households (especially infants).”
Dr. Jason’s paper says that compared to milk-based powdered formula, milk-based ready-to-feed formula costs 84 cents more per day, and milk-based concentrate costs 38 cents more per day.
Soy-based concentrate costs the same as soy-based PIF, and soy-based RTF costs 24 cents less a day than soy-based PIF.
Dr. Jason has been an expert witness in legal cases related to Cronobacter infection.