Pathogens most commonly associated with powdered formula:
(1) Salmonella enterica or other species
(2) Enterobacter sakazakii
(3) other enteric Gram-negative bacteria
Infections that may occur:
(1) diarrhea
(2) bacteremia
(3) meningitis
Risk factors for serious infection:
(1) poor process control at the production plant resulting in high level contamination
(2) poor quality product (which might be all that is available to a person in a developing country)
(3) infant with defective immunity
(4) neonates <= 28 days old and/or preterm
(5) caregivers unaware of the risks or association with the formula
(6) cross contamination during storage and preparation
(7) improper storage (unrefrigerated storage of reconstituted formula)
Reconstitution with water >= 70°C should minimize the risk associated with low level contamination.
Many cases may go unrecognized and so the magnitude of the problem is greater than most people realize.
