Our Recommendations for all newborn babies:
• Breast is best!! Breast-milk contains all the nutrition newborn babies need and breastfeeding benefits both the mother and the baby.
• But if infant formula is the only option then…
Full-term (37-42 weeks) and Healthy Newborns:
• Powdered infant formula is not sterile which means it may contain bacteria, however these bacteria almost never cause illness as long as the milk is prepared and stored properly.
• Healthy term babies have an extremely low risk of infection by Enterobacter sakazakii from powdered infant formula.
• If you are not breast-feeding the next best alternative is dairy-based powdered infant formula.
• It is now recommended that when preparing dairy-based powdered infant formula you only prepare the amount you need for baby’s next feed, and that you prepare it as close as possible to feeding time.
(A more detailed Guideline for preparing Infant Formula safely is given below.)
Premature, Low Birth Weight and Sick Babies (admitted to Neonatal Units):
• Breast milk is best for these babies too, but some may need formula or additional milk powder added to their 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 no risk of infection for babies given this formula.
• If no alternative to powdered formula is available then strict preparation and administration guidelines should be followed to minimise infection risk. Parents of premature babies should check with their neonatal unit staff.
Q Why these new recommendations ?
A Recently there has been concern internationally about Enterobacter sakazakii in powdered infant formula. This advice is provided to assist parents and caregivers.
Q What is Enterobacter sakazakii?
A It is a bacteria which is found in the environment and can sometimes contaminate food, and this includes powdered infant formula. The bacteria may be present in the powder on purchase or can be introduced at the time of preparation. Using safe methods of preparation and storage of the formula will reduce the risk of illness.
(A more detailed Guideline for preparing Infant Formula safely is attached.)
Q How large is this risk ?
A In the last 20 years, there have been approximately 50 cases reported worldwide of Enterobacter sakazakii infection in infants under 60 days old.Although infection is rare, infection has resulted in serious illness and death.
Most of the infants reported to have this infection were premature (born over 1 month early) or low birth weight (under 2.5 kg or 5 1/ 2 pounds), and almost all were in a Neonatal Intensive Care Unit. Infants with HIV or other illnesses with immune suppression are also at increased risk.
Recently a baby in New Zealand died from Enterobacter sakazakii infection, which may have come from a powdered infant formula.
Q Are full-term, healthy infants at risk ?
A The infants at higher risk are premature or low birth weight infants. There have been a few cases of this infection in previously healthy full-term infants however the risk is extremely low in these babies.
Q How can the risk of Enterobacter sakazakii infection be reduced in my formula-fed baby?
A Powdered infant formula has been pasteurised but is not sterile. If you are using powdered formula you should prepare only the amount of formula required for your baby’s next feed, and prepare it as close as possible to the feeding time.
Ready to feed liquid formula used in hospital neonatal units is sterile. Ready to feed liquid formula is only supplied to hospitals.
All this information is subject to a disclaimer.
Contact for enquiries
New Zealand Food Safety Authority
68-86 Jervois Quay
PO Box 2835
Wellington
NEW ZEALAND
Phone: +64 4 463 2500
Fax: +64 4 463 2501
Before making up the formula:
• Make sure the powdered formula is stored in a clean dry place. Keep the formula covered, and check the use-by date. Use the powder within 4 weeks of opening the tin.
Uncovered formula can become contaminated by bacteria or viruses carried on dust particles in the air or present in the environment.
• Sterilise bottles and teats (ask your Lead Maternity carer, Well child nurse or chemist for more information on how to do this if you’re not sure).
• For at least the first 3 months, all water (including bought water) used to make up formula should be boiled and cooled on the day it is used. Boil for 3 minutes on the stove top or until an automatic kettle switches off. Keep boiled water covered while it cools and until you need to use it.
• Water from tanks or bore holes should still be boiled and cooled for babies and toddlers until they are about 18 months old.
Unboiled water and unsterilised bottles can carry bacteria and viruses that can make baby ill.
Mixing the Formula:
• Always wash your hands thoroughly before preparing bottle feeds. Keep everything you use to make up baby’s feeds clean. Be especially careful in the first 3 months.
• Make up the formula carefully using the boiled, cooled water you have already prepared and following the instructions on the packaging exactly. Infant formula is balanced for baby’s nutritional needs, a stronger or weaker formula can harm baby.
• If baby is hungry and demands more, give more formula at each feed or give them an extra feed. Do not alter the formula strength.
• We recommend that you only prepare the amount you need for baby’s next feed, and that you prepare it as close as possible to feeding time.
Warming the Formula
• Formula can be heated by placing the bottle in a container of hot water.
• Microwaves can heat unevenly. If using a microwave, prepare the milk in a clean jug and pour it into the bottle before use, or at least shake the milk thoroughly after heating and leave to stand for 2 - 3 minutes. Shake again before using.
• Test the temperature of the milk on your skin – it should feel just warm (about body temperature).
• Use warmed formula within 20 minutes.
• Some babies may be quite happy fed with milk at room or fridge temperature.
Handling Prepared Formula:
• Throw out any formula that is left in the bottle after a feed, and wash and resterilise the bottle. Never reheat formula that has already been warmed or offered for feeding.
If you have to prepare a bottle in advance:
• If you have to prepare a bottle in advance (for a baby-sitter, or to take out with you), keep the prepared bottle at 4°C in the back of the fridge (check your fridge temperature).
• If carrying a bottle with you, keep the bottle cold in a chilly bin or insulated carrier.
• Throw out any prepared formula that’s been out of the fridge for more than 4 hours.
• Prepared formula should not be kept in the fridge any longer than 24 hours and ideally shorter times are better.
The temperature that babies like their formula is also a perfect temperature for harmful bugs to grow. Following the above guidelines means you will generally not be giving the bacteria a chance to grow to levels that can make baby sick. Please keep in mind that although infant formula powder is pasteurised it is not sterile (it can contain very low levels of bacterias) and in addition, there are lots of ways powder can accidentally be contaminated in the home. By taking care with handling and storage of prepared formula you can still protect baby from foodborne illness.
All this information is subject to a disclaimer.
Contact for enquiries
New Zealand Food Safety Authority
68-86 Jervois Quay
PO Box 2835
Wellington
NEW ZEALAND
Phone: +64 4 463 2500
Fax: +64 4 463 2501