Studies trace infant infections to unsafe formula preparation

Coliform bacteria thrive in powdered baby food.
Should milk formula get the frosty treatment?

By Katherine Addleman

There have been two such cases in Canada -- neither fatal, both occurring in hospital in the early 90s. But even when babies pull through, permanent severe neurological problems and other complications are common. What's not certain is whether Canadian docs are tuned in to this danger lurking in baby foods. "Most doctors and parents aren't well informed," says Kelly Sant, chief clinical dietician for the NICU at the Montreal Children's Hospital. In the past, outbreaks of E sakazakii were considered rare and have been traced back to contamination in factories that make baby formula (see "Baby killing bacterium lurks in powdered milk formula," NRM Vol 1, No 2, page 3). But two recent British studies show that the problem is widespread and the preparation of foods not the manufacturing process is to blame.

Getting the formula right Dietician Kelly Sant offers some quick baby formula facts for you and your patients Only prepared liquid formulas are sterile Powdered products -- breast milk fortifiers, formulas for babies with specific metabolic conditions and powdered soy-based formulas -- shouldn¹t be stored longer than 24 hours in the fridge or one hour at room temperature Unopened sterile liquid formulas have to be discarded if they¹ve been warmed up, opened and left out of the fridge for more than an hour Health Canada¹s physician advisory is available on their website: www.hc-sc.gc.ca/food-aliment/mh- dm/mhedme/e_enterobacter_sakazakii.html

POWDERED MENACE
The new data, presented at the annual meeting of the American Society for Microbiology in June, pointed to a shockingly wide distribution of E sakazakii in baby food products -- from milk formula preps to milk powder and dried baby foods. Two hundred samples from 110 different foods bought in seven European countries, the US, South Korea and South Africa were tested. Dr Stephen Forsythe and his team from Nottingham Trent University discovered that eight out of 82 formula samples and 12 of 49 dried infant foods were contaminated.

In a companion study, the same researchers looked at how homes and hospitals prepared the foods and formulas, and identified a number of risky practices. Dr Forsythe's team noted that a lot of parents have the blissful misconception that baby foods are sterile. In fact, although they're regulated, commercial baby foods are allowed to contain a small number of microbes. When mum or dad prepares the foods in advance -- a popular time-saving practice -- the bugs have time to multiply to alarming levels. In the fridge, the number of bacteria doubles every 10 hours. But when prepared foods are left at room temperature, the replication rate is astounding -- the bacteria double every half-hour. Dr Forsythe points to the truly terrifying prospect of foods left on a counter overnight.

STERILE IS BEST
Dietician Kelly Sant designed a protocol for the preparation of formula and baby foods used in the Montreal pediatric ICU, but she says that procedures haven't been standardized across the country yet. "We recommend that parents use ready-to-use formula, or liquid concentrate, which are really sterile," she says. A spokesperson for Health Canada says that Canadian physicians received an alert about the danger, and more info is available on their website.

According to the Food Standards Agency in the UK, healthy full-term babies have immune systems that can cope with this gut bug. But they warn that preemies or babies with immune deficiencies are at higher risk. The WHO, however, broadcasts stiffer warnings, stating that E sakazakii is very risky for any kids under a year. For example, a healthy full-term infant in Iceland suffered permanent brain damage from an E sakazakii infection. Preterm, immunocompromised or low birth-weight babies, and those born to HIV-positive mothers are especially susceptible. Under Canadian leadership, the WHO has set up a group that will update recommendations for E sakazakii specifications in baby foods.