Safety aspects in preparation and handling of infant food.

Powdered infant formula (PIF) can become contaminated during production with harmful bacteria such as Cronobacter spp. (formerly Enterobacter sakazakii). Inadequate conditions of preparation and handling of PIF can therefore exacerbate the risk of severe infection, especially in preterm infants. The WHO emphasized three main interventions for preparation and handling of PIF: (1) to dilute the powdered milk in water at a temperature of at least 70°C to inactivate Cronobacter spp.; (2) to consume milk right after each preparation, and (3) to store reconstituted milk at <5°C. The European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the French Food Safety Agency (Afssa) disagree with the heating process because of possible adverse effects on nutrients and the risk of severe burns. In home settings, PIF should be prepared fresh for each meal and be kept warm in bottle warmers or thermos bottles. In institutional settings, written guidelines for preparation and handling of PIF should be established. The use of sterile liquid formula is encouraged for healthy newborn infants in maternity wards; PIF should be prepared on a daily basis. Safe infant feeding involves the production of microbiologically cleaner infant formula by industry, and both education and support for the caregivers in preparing and handling the formula.