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Published on: March 5, 2014
Prevalence of bacterial contamination of powdered infant feeds in a hospital environment
L V Marino1, E Goddard, A Whitelaw
1Department of Dietetics, Red Cross War Memorial Children's Hospital and School of Adolescent and Child Health, Cape Town, South Africa. lmarino@pgwc.gov.za
Insights
Bacterial contamination is a significant risk in powdered infant feeds (PIFs), even in controlled settings. Ready-to-use (RTU) infant feeds are sterile and recommended for hospitalized infants to prevent infections.
Area of Science:
- Neonatal Nutrition
- Microbiology
- Public Health
Background:
- Concerns exist regarding the safety of powdered infant feeds (PIFs) due to bacterial contamination.
- This contamination poses risks, especially for vulnerable infants like premature or immunocompromised neonates.
- A shift towards ready-to-use (RTU) infant feeds is being considered as a safer alternative.
Purpose of the Study:
- To assess the prevalence of bacterial contamination in PIFs used for infants.
- The study specifically focused on samples from Red Cross War Memorial Children's Hospital in Cape Town.
Main Methods:
- Quantitative bacterial contamination levels were measured in colony-forming units (CFUs) per milliliter.
- Milk samples underwent incubation at various temperatures and durations (25°C overnight, 30°C overnight, 30°C for 6 hours).
- Contamination was defined as any positive culture pre-administration or >10² CFU/ml post-administration.
Main Results:
- A high proportion of PIF samples showed bacterial contamination: 50/82 (61%) pre-incubation, with 30.4% heavily contaminated (>10⁴ CFU/ml).
- Post-incubation, 43/92 samples (46.7%) exceeded the contamination threshold of >10² CFU/ml.
- Acidification of PIFs demonstrated a limited bactericidal effect.
Conclusions:
- Sterile RTU infant feeds are recommended for all hospitalized infants.
- Significant bacterial contamination of PIFs occurs even with controlled preparation.
- Efforts should prioritize the use of sterile RTU systems for hospitalized infants, given their availability.
Background:
The study arose as part of a best-practice nutrition model regarding the introduction of ready-to-use (RTU) infant feeds in place of powdered infant feeds (PIFs) as a standard formula for infants under the age of 1 year who are unable to be breastfed. Internationally and locally there is grave concern regarding the safety and efficacy of mixing PIFs, especially in a hospital setting, and the resultant bacterial contamination causing enteric infections, especially in premature, immunocompromised and sick infants.
Objective:
To evaluate the prevalence of bacterial contamination of PIFs given to infants at Red Cross War Memorial Children's Hospital, Cape Town.
Methods:
Quantitative levels of bacterial contamination were determined and were expressed as colony-forming units (CFUs) per millilitre of sample. Aliquots of milk were inoculated onto agar, and the milk samples were then incubated at 25 degrees C overnight (N = 10), 30 degrees C overnight (N = 48) and 30 degrees C for 6 hours (N = 34). Post-incubation milk samples were cultured again. Contamination was defined as any positive culture before administration (i.e. pre incubation) or > 10(2) CFU/ ml after administration (i.e. post incubation).
Results:
Fifty samples of PIFs (N = 82) were contaminated pre incubation, with 25/82 samples (30.4%) being heavily contaminated ( >or= 10(4) CFU/ml). Post incubation, 43/92 samples (46.7%) were contaminated with > 102 CFU/ml. The acidified PIFs appeared to have some bactericidal effect against some of the organisms, but not all.
Conclusions:
RTU infant feeds are sterile and are recommended for use in all hospitalised infants. The results of this study indicate that even when milk is prepared in a controlled environment there is significant bacterial contamination of PIFs post production. As RTU feeds are now readily available in South Africa every attempt should be made to use a sterile RTU system for hospitalised infants.
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