April 12th, 2017

Tainted Formula


Say No To Chrono



By Brian W. Donnelly, MD, IBCLC, Pediatric Alliance — North Hills.


I remember reading the MMWRs (Morbidity and Mortality Weekly Report — the CDC’s weekly update on selected causes of disease and death) about Enterobacter sawazakii meningitis many moons ago, when I was a resident. They were chilling accounts of neonates succumbing to overwhelming bacterial infections. Sadly, thirty years later, such cases still happen.

In 2007, the sneaky bacteria underwent a name change to Cronobacter sawazakii, but the creature didn’t change its stripes. Despite advances in neonatal care, mortality rates related to Cronobacter meningitis remain around 50%. And babies that survive often have neurological disabilities.

While Cronobacter bacteria can be found anywhere in the environment, the disturbing connection is the presence of this varmint in powdered infant formula. From a biological perspective, this is a remarkable achievement. It eludes eradication that virtually all other bacteria cannot. From a humanitarian perspective, this is unacceptable. So we need to take extra precautions. Yesterday on The PediaBlog, my colleague Sara DePierre reviewed the recommendations from the World Health Organization on the safe preparation, storage and handling of powdered infant formula. (You can read Sara’s post here and the guidelines here.)

Meticulous attention to detail can minimize exposure to bacteria from the environment (like the kitchen). The crucial point in preparing powdered formula is to boil the water and add the water to the powder when it is no cooler than 70 degrees Centigrade (158 degrees Fahrenheit). The formula mix should then be shaken, not stirred. (Martini aficionados should be able to remember this one easily.  : > )

For some, avoiding powder formula may be the best solution. But if that is not in the budget, these extra steps should help protect the babies, especially those born prematurely. Of course, breastfeeding is an even cheaper and safer option. When that is not possible, we should do what we can to keep babies safe from Cronobacter.

Forewarned is forearmed.


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    Ned Ketyer, M.D.

    Ned Ketyer, M.D.

    Dr. Ketyer has special interests in developmental pediatrics and preventative medicine, specifically how nutrition and the environment affect health. He earned his bachelor’s degree from the University of Vermont and his medical degree from Northwestern University Medical School. He completed his residency at Children’s Hospital of Pittsburgh.

    As one of the founding physicians of Pediatric Alliance, PC, Dr. Ketyer served as its president from 1997-2004. He has been practicing general pediatrics at Pediatric Alliance since 1990. Dr. Ketyer and his wife have three boys and live in Pittsburgh's South Hills. 

  • Note: The information included in these posts is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice.

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