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Dear Parents,
Cronobacter, formerly called Enterobacter sakazakii, is a bacteria that can continue to exist in very dry arrid conditions, and is therefore very hard to eliminate during production of powdered  infant formula, powdered milk, herbal teas, and starches. Although Cronobacter- related illness is rare, it can prove fatal to small infants, the elderly, and anyone with a weakened immune system. Although  FDA's current  "good manufacturing requirements" (GMR) do set a limit for the presence of Cronobacter, powdered  infant formula manufacturers report that it is not possible to ensure zero contamination using present methods. In addition, infant formula may continue to be contaminated  after the container has been opened by the consumer.

 Cronobacter bacteria can cause severe blood infections (sepsis) or meningitis (an inflammation of the membranes that protect the brain and spine). Infants 2 months of age and younger are most likely to develop meningitis if they are infected with Cronobacter. Infants born prematurely and those with weakened immune systems are also at increased risk for serious sickness from Cronobacter. 

In infants, the sickness generally starts with fever. It usually includes poor feeding, crying, or very low energy. Young infants with these symptoms should be taken to a doctor.

Not Just Infants

Cronobacter can also cause diarrhea, problems in wounds, and urinary tract infections in people of all ages. The elderly and people whose bodies have trouble fighting germs because of a sickness they already have are most at risk.

The Center for Disease Control (CDC) has recently issued the  following recommendations to decrease the risk of contracting an infection with Cronobacter bacteria:
Breastfeed. Breastfeeding helps prevent many kinds of sicknesses among infants. Almost no cases of Cronobacter sickness have been reported among infants who were being exclusively breastfed (meaning, the baby was fed only breast milk and no formula or other foods).

If your baby gets formula, choose infant formula sold in liquid form, especially when your baby is a newborn or very young. Liquid formulations of infant formula are made to be sterile and should not contain Cronobacter germs.
If your baby gets powdered infant formula, follow these steps.
If your baby gets powdered infant formula, there are things you can do to protect your baby from sickness from many germs – not just Cronobacter. Good hygiene, mixing the formula with water hot enough to kill germs, and safely storing formula can prevent growth of Cronobacter and other germs. These are keys to keeping your baby safe and healthy.

Clean up before preparation

Wash your hands with soap and water
Clean bottles in a dishwasher with hot water and a heated drying cycle, or scrub bottles in hot, soapy water and then sterilize them
Clean work surfaces, such as countertops and sinks

Prepare safely

Keep powdered formula lids and scoops clean (be careful about what they touch)
Close containers of infant formula or bottled water as soon as possible
Use hot water (158 degrees F/70 degrees C and above) to make formula
Carefully shake, rather than stir, formula in the bottle
Cool formula to ensure it is not too hot before feeding your baby by running the prepared, capped bottle under cool water or placing it into an ice bath, taking care to keep the cooling water from getting into the bottle or on the nipple
Before feeding the baby, test the temperature by shaking a few drops on your wrist

Use up quickly or store safely

Use formula within 2 hours of preparation. If the baby does not finish the entire bottle of formula, throw away the unused formula.
If you do not plan to use the prepared formula right away, refrigerate it immediately and use it within 24 hours. Refrigeration slows the growth of germs and increases safety.
When in doubt, throw it out. If you can't remember how long you have kept formula in the refrigerator, it is safer to throw it out than to feed it to your baby.

Practice proper hygiene

Wash your hands carefully with soap and water, especially after using the toilet or changing diapers. Always wash your hands:

before preparing and feeding bottles or foods to your infant
before touching your infant's mouth, and
before touching pacifiers or other things that go into your infant's mouth.

If soap and water aren't available, use an alcohol-based hand sanitizer. These alcohol-based products can quickly reduce the number of germs on hands in some situations, but they are not a substitute for washing with soap and water.
It is also important to keep all objects that enter infants' mouths (such as pacifiers and teethers) clean. 

Doctor Nass and his staff remain committed to providing the highest level of pediatric care, combining expert training, the latest medical technologies and over 25 years of experience serving the community.

You can reach our office at (718)520-1070 for all of your pediatric needs.
Check us out at   www.doctornass.com 

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Howard Nass MD FAAP and staff

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