Advice for parents regarding infant formula from the Ministry of Health and NZ Food Safety Authority
Enterobacter sakazakii infections in premature babies
Our Recommendations for all newborn babies:
• Breast is best!! Breast-milk contains all the nutrition newborn babies need and breastfeeding benefits both the mother and the baby.
• But if infant formula is the only option then…
Full-term (37-42 weeks) and Healthy Newborns:
• Powdered infant formula is not sterile which means it may contain bacteria, however these bacteria almost never cause illness as long as the milk is prepared and stored properly.
• Healthy term babies have an extremely low risk of infection by Enterobacter sakazakii from powdered infant formula.
• If you are not breast-feeding the next best alternative is dairy-based powdered infant formula.
• It is now recommended that when preparing dairy-based powdered infant formula you only prepare the amount you need for baby’s next feed, and that you prepare it as close as possible to feeding time.
See guideline for preparing Infant Formula safely
Premature, Low Birth Weight and Sick Babies (admitted to Neonatal Units):
• Breast milk is best for these babies too, but some may need formula or additional milk powder added to their expressed breast milk.
• If not breastfed, these babies should be fed ready-made liquid formula instead of powdered milk formula. Ready-made liquid formula is sterilised in the bottle, which means there is no risk of infection for babies given this formula.
• If no alternative to powdered formula is available then strict preparation and administration guidelines should be followed to minimise infection risk. Parents of premature babies should check with their neonatal unit staff.
Questions and answers
Q Why these new recommendations?
A Recently there has been concern internationally about Enterobacter sakazakii in powdered infant formula. This advice is provided to assist parents and caregivers.
Q What is Enterobacter sakazakii?
A It is a bacteria which is found in the environment and can sometimes contaminate food, and this includes powdered infant formula. The bacteria may be present in the powder on purchase or can be introduced at the time of preparation. Using safe methods of preparation and storage of the formula will reduce the risk of illness.
(A more detailed Guideline for preparing Infant Formula safely is attached.)
Q How large is this risk?
A In the last 20 years, there have been approximately 50 cases reported worldwide of Enterobacter sakazakii infection in infants under 60 days old. Although infection is rare, infection has resulted in serious illness and death.
Most of the infants reported to have this infection were premature (born over 1 month early) or low birth weight (under 2.5 kg or 51/2 pounds), and almost all were in a Neonatal Intensive Care Unit. Infants with HIV or other illnesses with immune suppression are also at increased risk.
Recently a baby in New Zealand died from Enterobacter sakazakii infection, which may have come from a powdered infant formula.
Q Are full-term, healthy infants at risk?
A The infants at higher risk are premature or low birth weight infants. There have been a few cases of this infection in previously healthy full-term infants however the risk is extremely low in these babies.
Q How can the risk of Enterobacter sakazakii infection be reduced in my formula-fed baby?
A Powdered infant formula has been pasteurised but is not sterile. If you are using powdered formula you should prepare only the amount of formula required for your baby’s next feed, and prepare it as close as possible to the feeding time.
Ready to feed liquid formula used in hospital neonatal units is sterile. Ready to feed liquid formula is only supplied to hospitals.
