Media Release

27 August 2004

Infant Formula Advice Strengthened

The Ministry of Health and the New Zealand Food Safety Authority have strengthened advice to hospital neonatal units and reinforced advice to parents and health professionals about preparation and storage of infant formula.

This follows the death of a premature baby linked to bacteria which may be found in both the environment and in powdered formula.

Ministry of Health Chief Advisor Child and Youth Health Dr Tuohy says the Ministry and Food Safety Authority wish to reduce the risk of other premature babies dying from the bacteria called Enterobacter sakazakii.

Enterobacter sakazakii is a bacteria reported internationally as being commonly found in both the environment and at very low levels in infant formula.

Hospital neonatal units have been advised that premature babies who are not breast fed should now be fed ready-made liquid formula instead of powdered milk formula. Ready-made liquid formula is sterilised in the bottle, which means there is far less risk of infection for premature babies given this formula.

Health authorities have in the past recommended to parents and caregivers that infant formula be stored in the fridge for a maximum of 24 hours after preparation. While that still remains an accepted time internationally, and is the advice printed on infant formula labels , it is now recommended that, as a precaution, that powdered infant formula should be prepared immediately before feeding, and that caregivers only prepare the amount they need for baby’s feed.

That strengthened advice will be provided to health professionals who in turn provide advice to parents on preparing infant formula for babies.

Dr Pat Tuohy says staff at the Ministry and the Food Safety Authority would like to express their sympathy for the family affected by the death.

He says the family have advised their paediatrician that they wish to grieve for their baby privately and have asked their request for privacy be passed on to the media.

NZ Food Safety Authority Principal Advisor Donald Campbell says that although the milk used in powdered infant formulas is pasturised, the powder is not able to be sterilised, as sterilisation would effectively remove a number of nutrients that are needed for baby's development.

He says that means that there is a risk that some bacteria, which can be present in the formula in very small amounts, which when mixed with water and stored above 4 degrees Celsius can grow to a level able to cause sickness, and in extreme cases death.

Dr Campbell says the risk to full term, healthy babies is regarded as extremely low. However the risk to premature, low birth weight or very sick babies, while still low, is higher.

"While the risk from Enterobacter sakazakii is generally regarded as extremely small, particularly for full term healthy babies, it's timely for both the Ministry and the Food Safety Authority to remind parents and health professionals of the precautionary steps they can take to reduce this risk.

This advice includes:

• breastfeed. Breast is best!! Breast-milk contains all the nutrition newborn babies need and breastfeeding benefits both the mother and the baby
• if infant formula is the only option, it is now recommended that dairy-based infant formula be used. When preparing powdered infant formula parents should only prepare the amount needed for baby’s feed, and it should be prepared as close as possible to feeding time
• if babies are premature, have a low birth weight (less than 2.5kg) or are sick enough to have been admitted to a hospital neonatal unit, then breast milk is best for these babies too, but some may need formula or additional milk powder added to their mother's 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 far less risk of infection for babies given this formula. Ready to feed liquid formula is only supplied to hospitals.
• if no alternative to powdered formula is available for higher risk babies then strict preparation and administration guidelines should be followed to minimise infection risk. Parents of premature babies should seek advice from their neonatal unit staff.

Dr Tuohy says that any parents or caregivers seeking advice about infant formula should contact their midwife, plunket nurse or GP.