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Risk of Cronobacter infection in powdered infant formula

The US Food and Drug Administration recently outlined the risks and symptoms of Cronobacter infection in young infants, and how to reduce risk of infection.

In an effort to ensure the safety of powdered infant formula, the US Food and Drug Administration (FDA) informed parents about Cronobacter infection and its risk in infant formula.

Cronobacter is a natural bacterium capable of surviving on most surfaces, especially dry food. This includes powdered infant formula, powdered milk, herbal teas, and starches. Most people are not affected by Cronobacter, but infections can be life threatening in infants. Infants aged under 2 months, immunocompromised, or of low birthweight are especially at risk.

While liquid formulas undergo treatments that leave them sterile, powdered formulas do not receive these same processes, allowing Cronobacter to contaminate them. Cronobacter can enter interior spaces through hands or soles of shoes, then live on interior surfaces such as bottles or counters.

Cronobacter can contaminate powdered formula in factories through contaminated ingredients or contact between the formula and a contaminated surface. In houses, Cronobacter can contaminate powdered formula from utensils used for feeding that aren’t properly sanitized, inadequate handwashing prior to formula preparation, contact between formula lid or scoop and contaminated surface, or contaminated water used to mix formula.

As Cronobacter is common in the environment, it can be difficult to track the source of contamination. Also, Minnesota is the only US state that requires reporting of Cronobacter cases to authorities. Most of the time, cases go unreported, providing scientists with little information about the genetic makeup of bacteria in cases that are reported.

To safely prepare powdered infant formula, parents and guardians should follow the manufacturer’s instructions. Ready-to-feed infant formula should be used in infants aged less than 2 months, immunocompromised, or of low birthweight.

Liquid formula is the safest option, but use of hot water in preparation and waiting for cooling can help protect against Cronobacter. This should be done with caution, as some products warn against heating. Instructions on the packaging should be consulted before preparation.

Proper cleaning, sanitizing, and storing of bottles and breast pump parts is also important for avoiding infection. When washing hands before preparation, the Centers for Disease Control and Prevention recommended using alcohol-based hand sanitizer with at least 60% alcohol.

Symptoms of Cronobacter infection includes fever, poor feeding, excessive crying, and very low energy. Seizures may also occur in some infants. The FDA urged caregivers to take infants to a medical provider right away should they display any of these symptoms.

Reference

What to know about the risk of Cronobacter in powdered infant formula. US Food and Drug Administration. October 20, 2022. Accessed October 21, 2022.https://www.fda.gov/consumers/consumer-updates/what-know-about-risk-cronobacter-powdered-infant-formula