We just got out of the hospital with our new baby. While we were in there, they gave us some literature on powder infant formula that it is not a sterile product and can pose a risk to babies, mostly if it is prepared and handled unsafely. They suggested that we only use liquid. Has anyone else heard of this? I've looked on the Canadian Pediatrics Society website and there is nothing about powdered formula being unsafe.

asked 01 Jul '10, 00:19

Dee's gravatar image

accept rate: 33%

Interesting, I had never heard this before but after poking around, I found this commentary published in Pediatrics (PEDIATRICS Vol. 110 No. 4 October 2002, pp. 833-835). It says:

Powdered formula is made from pasteurized (ie, sterile) liquid that is then freeze-spray dried into a powder. It is possible for organisms to be introduced in the final stages of production. The preparation of infant formula for special care nurseries within institutions is not regulated by law. The most widely followed guidelines are those of the American Dietetic Association (ADA) issued in 1991 and amended since the E sakazakii warning12 (www.eatright.org/formulaguide.html). These guidelines are presently being reviewed and updated. The amended guidelines suggest using ready-to-feed or concentrated formulas rather than powdered formulas in neonatal intensive care nurseries. As they stand, the guidelines call for the use of aseptic technique in a designated formula preparation room. The guidelines call for the refrigeration of prepared formula so that a temperature of 2° to 3°C is reached by 4 hours after reconstitution.

The link it references, eatright.org, no longer works. When I went to that site, I couldn't find any reference to this document. However, I did find an article labeled, Formula Basics for Healthy Babies. It makes no mention of ready-to-use formula being safer.

The World Health Organization has a pdf booklet from 2007 that discusses the risks of prepared infant formula (pif) in detail. It says:

Where available, commercially sterile ready-to-feed liquid infant formula should be used for infants at greatest risk. Sterile liquid infant formula does not contain pathogenic microorganisms and so does not pose a risk of infection. However, its use may not always be an option, and the use of PIF may be required. PIF is not a sterile product and may contain harmful bacteria. Reconstituted PIF provides an ideal environment for the growth of these pathogens. Even if present in powdered formula at very low levels, inappropriate preparation and handling of reconstituted PIF provides ideal conditions for these pathogens to multiply, which greatly increases the risk of infection. However, the risk of illness can be reduced if PIF is prepared safely and handled correctly.

The FDA suggestion, which appear to have been updated in 2007, says:

In most cases, it's safe to mix formula using ordinary cold tap water that's brought to a boil and then boiled for one minute and cooled. According to the World Health Organization, recent studies suggest that mixing powdered formula with water at a temperature of at least 70 degree C—158 degrees F—creates a high probability that the formula will not contain the bacterium Enterobacter sakazakii—a rare cause of bloodstream and central nervous system infections. Remember that formula made with hot water needs to be cooled quickly to body temperature—about 98 degrees F—if it is being fed to the baby immediately. If the formula is not being fed immediately, refrigerate it right away and keep refrigerated until feeding.

If you decide to use powdered formula, the University of Michigan Health System has a very nice article about using "safe water" for powdered formula.


answered 01 Jul '10, 01:43

Kiesa's gravatar image

Kiesa ♦
accept rate: 26%

+1 Very interesting & informative answer.

(01 Jul '10, 08:31) Emi

Great research, thanks!

(01 Jul '10, 11:03) brandstaetter
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Asked: 01 Jul '10, 00:19

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Last updated: 01 Jul '10, 01:43