Cronobacter Support
07-23-2009, 10:40 AM
PEDIATRICS Vol. 110 No. 4 October 2002, pp. 833-835
pediatrics.aappublications.org/cgi/content/full/110/4/833
Infant Formula Safety(cont'd)
The recommendations by the CDC and the FDA pertain to intensive care nurseries only, suggesting that these vulnerable infants are at most risk. Present practice leads to early discharge from the NICU, so a significant number of premature infants are being cared for at home. Should the precautions be extended to this group? A few term infants will be immune compromised. Are they at risk and can they be identified? Perhaps newborns could be protected from enterically introduced pathogens in other ways—for example, probiotics or prebiotics.
A number of problems and questions have been brought to the forefront by the E sakazakii issue that require urgent answers: 1) No universally followed standards exist for formula labs. Physicians should take the lead in examining their institutions’ formula lab policies and should work with clinical nutrition departments and pharmacies to develop standardized policies and procedures for formula preparation and handling. Surveillance policies should also be developed to monitor quality and safety of formulas prepared and used in hospitals. The present ADA guidelines should be updated, but for now, offer practical guidance. 2) Infant formula needs to be handled in a way to reduce the chance of infection. This starts with the manufacture and finishes with the way the formula is administered. 3) The CDC and FDA recommendations, if implemented, will improve the safety of formula feeding in the NICU. The preponderance of evidence does not support using boiling water as recommended by the FDA. 4) It is presently unknown whether powdered formula contamination effects groups other than premature infants in NICUs. Other populations need to be studied and new ways of protecting all infants from foodborne diseases sought.
Robert D. Baker, MD, PhD
Digestive Disease and Nutrition Center
Children’s Hospital of Buffalo
Buffalo, NY 14222
FOOTNOTES
Received for publication Aug 15, 2002; Accepted Aug 15, 2002.
pediatrics.aappublications.org/cgi/content/full/110/4/833
Infant Formula Safety(cont'd)
The recommendations by the CDC and the FDA pertain to intensive care nurseries only, suggesting that these vulnerable infants are at most risk. Present practice leads to early discharge from the NICU, so a significant number of premature infants are being cared for at home. Should the precautions be extended to this group? A few term infants will be immune compromised. Are they at risk and can they be identified? Perhaps newborns could be protected from enterically introduced pathogens in other ways—for example, probiotics or prebiotics.
A number of problems and questions have been brought to the forefront by the E sakazakii issue that require urgent answers: 1) No universally followed standards exist for formula labs. Physicians should take the lead in examining their institutions’ formula lab policies and should work with clinical nutrition departments and pharmacies to develop standardized policies and procedures for formula preparation and handling. Surveillance policies should also be developed to monitor quality and safety of formulas prepared and used in hospitals. The present ADA guidelines should be updated, but for now, offer practical guidance. 2) Infant formula needs to be handled in a way to reduce the chance of infection. This starts with the manufacture and finishes with the way the formula is administered. 3) The CDC and FDA recommendations, if implemented, will improve the safety of formula feeding in the NICU. The preponderance of evidence does not support using boiling water as recommended by the FDA. 4) It is presently unknown whether powdered formula contamination effects groups other than premature infants in NICUs. Other populations need to be studied and new ways of protecting all infants from foodborne diseases sought.
Robert D. Baker, MD, PhD
Digestive Disease and Nutrition Center
Children’s Hospital of Buffalo
Buffalo, NY 14222
FOOTNOTES
Received for publication Aug 15, 2002; Accepted Aug 15, 2002.