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Preparing Powdered Infant Formula Australian Guidelines vs World



                       Preparing Powdered Infant Formula
               Australian Guidelines vs World Health Organisation
The Australian Infant Feeding Guidelines for Health Workers (1) recommends the addition
of powdered infant formula to cooled or ‘lukewarm’ boiled water. This approximates body
temperature - about 37 degrees C.

In contrast, the World Health Organisations (WHO) Guidelines for the safe preparation,
storage and handling of powdered infant formula (2) recommends that powdered infant
formula be added to boiled water, cooled to a temperature of no less than 70 degrees C.

The basis of the WHO’s recommendation is that powdered infant formula is not sterile
and that incorrect preparation has been linked with death and illness in susceptible infants
due to bacterial contamination by Enterobacter sakazakii (E.sakazakii) and other bacteria.

What is E.sakazakii?
      E. sakazakii is a bacteria found widely in the environment. It can cause illness
      (meningitis, necrotizing enterocolitis) and has been found on utensils used to
      prepare infant formula in hospitals. It grows rapidly in made up infant formula
      particularly if kept at around 37-44 degrees C for considerable periods of time. It
      can be killed by heat, but some strains are heat resistant. E.sakazakii has also
      been found in breast milk stored in a milk bank

      E.sakazakii infections have occurred mainly in hospital neonatal intensive care
      units, with preterm and very low weight infants most at risk. Infection arises when
      reconstituted infant formula is kept at room temperature or warmer for prolonged
      periods of time. Correct preparation and storage is essential to avoid outbreaks.

      Infant formula is not a sterile product. Heinz as a manufacturer of infant formula has
      rigorous processes in place to minimize possible bacterial contamination during
      production and to point of purchase.

Concerns about WHO recommendations to add powdered infant formula to water
more than 70 degrees C (3)

   1. E.sakazakii infection is rare, occurring at a rate of 0.001% in infants. It is mainly
      due to incorrect preparation and storage of infant formula in hospitals which can be
      corrected with proper hygiene measures and staff training.

   2. The risk of scalding the infant is high if formula is prepared with water at 70
      degrees C rather than lukewarm or body temperature of 37 degrees C. The formula
      needs to sit for approximately 30 minutes to cool to be suitable for feeding allowing
      bacteria to grow during this time.

        H.J Heinz Co. Australia (ABN 87 004 200 319) 2 Southbank Boulevard, Southbank, Victoria 3006

   3. Nutrients in the formula are at risk of being destroyed at this temperature.
      Susceptible nutrients to heat include thiamin, folate, pantothenic acid and Vitamin
      C. Amino acids, polyunsaturated acids and other active ingredients such as
      probiotics may also be affected. Addition of powder to hot water may also cause
      clumping of the formula, precipation of mineral salts, separation of fats and
      activation of bacterial spores, putting the infant at risk of other bacterial
      contamination. The infant formula may be reduced in quality – both nutritional and

   4. May encourage parents to make multiple formula bottles ahead of time rather than
      one bottle at a time due to the waiting time required to cool formula. This may
      increase the risk of bacterial contamination through incorrect storage

   5. Cause parental stress as :-

                Thermometers, not a common kitchen item will be required to measure
                Increased waiting time is required for cooling the formula before it can be fed
                to a hungry, demanding baby
                Dangers of scalds from steam
                Possibility of bottle top exploding when sealed bottle with prepared formula is

Heinz along with other infant formula manufacturers follow the current safety and hygiene
guidelines required under Australian law to ensure that infant formula fed to infant is safe
and nutritious. It is important that parents and carers follow the preparation and storage
instructions detailed on the can to prevent infections.


   1. NHMRC. Infant Feeding Guidelines for Health Workers. 2003. Commonwealth of
   2. WHO Guidleines for safe preparation, storage and handling of powdered infant
      formula 2007\
   3. Infant Nutrition Council . Position on the safe preparation and handling of powdered
      infant formula- concerns around WHO recommended to prepare at 70 degrees C

        H.J Heinz Co. Australia (ABN 87 004 200 319) 2 Southbank Boulevard, Southbank, Victoria 3006

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