Making up formula for use ivernight, do any of you ladies do this?

[newpositiveme]

I have a six week old DS who is FF. Obviously the current guidelines say not to make up and store formula, but it is working ouit very expensive to use the cartons for nighttime. Equally impractical to expect him to wait 20/30 mins for me to make up a fresh bottle from scratch when he wakes in the night!

With DS1 I always made and stored a few bottles in the fridge, DS was always perfectly healthy, no upset tummy etc.

Do any of you ladies do this, if so do you wait for the bottle to cool a bit before putting it in fridge or straight in? Have you encountered any problems?

Thanks

Good point pooka it really irritates me the way people think its ok to ignore new scientific evidence with the "I used to do it with no problems so it must be ok" argument.

As I child I quite often travelled unsecured in the boot of my dads estate (with the shelf off obviously he wasn't a monster :)) I was never injured from this so it must be ok to do the same now, right?

We used to beg to go in the boot. Would often be 3 or 4 of us. Only problem was not being able to wind the windows down because the grown ups were all smoking. Though my mother could clamber over the seats with drinks for us because she wasn't wearing a seat belt.

Never did us any harm though...

theborrowers iirc if you put it to the back of the fridge where it is coolest it is fine.

Pooka, ayjayjay, yes! That you don't or didn't follow guidelines is one thing and no one elses business. But to recommend that others do the same, sighting your lo's as "evidence"... [hangry]

from this site
"The literature suggests that premature infants and those with underlying medical conditions may be at highest risk for developing E. sakazakii infection. Several outbreaks have occurred in neonatal intensive care units worldwide. (See, for example, van Acker et al.(3).) However, an apparently healthy full term newborn infant in Iceland also became ill prior to hospital discharge and suffered permanent neurological sequelae (4). Although the reservoir of the organism is unknown, a growing number of outbreaks of infection among neonates has provided compelling evidence that milk-based powdered infant formulas have served as the source of infection (3-5). Significantly, the results of one investigation (the "Belgium outbreak" investigation (3)) suggest that even low levels of E. sakazakii in milk-based powdered infant formula (i.e., levels that are within what a 1994 Codex Alimentarius document (6) provides as a currently accepted limit for the presence of coliforms in milk-based powdered infant formula) can lead to development of infection."

and this page: www.invs.sante.fr/presse/2005/le_point_sur/salmonella_agona_040505/. is not opening today. It opened yesterday when I linked it to another thread yesterday in 'Living Overseas' I think.
the text from the cached copy is in French so I have provided the translation here using Google Translate.

Outbreak of salmonellosis due to Salmonella enterica serotype Agona in infants,
linked with the consumption of milk powders
France, January-April 2005
InVS point of the investigation in May 3, 2005

The Institute for Public Health is coordinating the investigation of a nationwide outbreak of salmonellosis due to Salmonella enterica serotype Agona occurred in infants since the beginning of 2005.

This investigation showed that this outbreak was linked to the consumption of powdered infant milk. To date, 123 infants with salmonellosis due to Salmonella Agona, were identified by the National Reference Center (NRC) for Salmonella. Families of 115 infants were interviewed.

This outbreak took place in two phases (Figure 1): the first phase in late December 2004 to mid-March 2005 was linked to the consumption of powdered milk brand Picot and involved 44 cases. Withdrawal and recall of baby products brand Picot took place March 4. The second phase associated with the consumption of several batches of milk powder brand Blédilait products in the same establishment as powdered milk Picot began during the fourth week of March and involved 69 cases. Withdrawal and a reminder of those lots was held on April 7.

The progress of investigations is detailed below.

Figure 1 - Weekly Distribution of the 115 infants (whose parents were interviewed) with salmonellosis due to Salmonella Agona, by week of symptom onset and in the milk consumed within 3 days of onset of symptoms, France, January- April 2005

Description of cases
To date, 123 infants aged 1 to 12 months, with salmonellosis in Salmonella Agona diagnosed between January and April 2005 were identified by the NRC for Salmonella.
The 115 infants whose families were interviewed live in 47 different departments (Figure 2). They developed symptoms of salmonellosis between 28 December 2004 and April 21, 2005. One hundred and eleven (97%) children had diarrhea, 68 (59%) with blood in stools and 88 (77%) fever. Forty-two (37%) children were hospitalized. The outcome was favorable for all.

Figure 2 - Geographic distribution of the 115 infants (whose parents were interviewed) with salmonellosis due to Salmonella Agona according to the department of residence. France, January-April 2005

Progress of investigations

On March 3, 2005, the CNR of Salmonella reported to InVS excessive strains Salmonella enterica serotype Agona for the period January-February 2005: 22 strains of S. Agona were isolated in January-February 2005 against eight strains averaged over the same period over the last five years. An epidemiological investigation was carried out by InVS to confirm the epidemic nature of the phenomenon, to measure the importance of generating hypotheses on the origin and source of the outbreak and to propose measures control and prevention measures.

Phase 1
March 4, parents of 19 children patients were asked about their food consumption, they had all eaten milk brand Picot in three days preceding the date of symptom onset.
Given these initial investigations, the producing establishment, in conjunction with the Directorate General for Competition, Consumption and Fraud Control (DGCCRF) and the Directorate General of Health (DGS), decided on March 4 the cessation of production, withdrawal of marketing and recall of all milk brand Picot.
A case-control study compared the food intake of 23 sick children ("cases") to that of 23 children without disease ("controls") of the same age, identified in the practice of physicians treating cases and laboratories that had isolated salmonella. All sick children had consumed milk Picot and none of the children do not ill had eaten.

A survey by the DGCCRF in the producing establishment has identified the manufacturing process of powdered milk, the types of products manufactured on the same chain of production and distribution areas. Environmental levies, milk powder and raw materials have been made. Seven strains of Salmonella Agona were isolated from environmental samples and milk powder. The molecular profile of these strains was identical to strains isolated from patients consuming milk Picot.

The results of these surveys have confirmed that milk powder brand Picot were the source of infection Salmonella Agona occurred in early 2005 in infants in France.
Withdrawal and recall of milk powders, March 4, has prevented the occurrence of new cases linked to the consumption of milk powders. Indeed, only four cases whose parents were not informed of the recall became infected after this date. No new cases have consumed powders that mark has been identified since April 18, 2005. In total, 44 infants were ill after consuming milk powder brand Picot.

Phase 2
During the fourth week of March, the NRC has been a further increase in the number of infants infected with Salmonella Agona. The questioning of the parents of these infants showed that they had all eaten within three days preceding the date of early symptoms of powdered milk brand Blédilait / Gallia 2nd age.
Meanwhile, the investigation of the DGCCRF in establishing producer of infant formula Picot showed that batches of infant milk powder brand Blédilait 2nd age were manufactured on the same production line as powdered milk brand Picot.

Milk powders Blédilait consumed by sick children belonged to the same batch (referenced below). The molecular profile of the strains isolated from patients consuming milk powders Blédilait was the same as strains isolated from sick consumers of milk powders Picot.

Samples of milk powders collected in boxes that had been consumed by sick infants were tested: strains Salmonella Agona were isolated from a second box Blédilait age and a lot 1229/BL7 box Blédilait second batch 1231/BL9 age.

The results of these surveys have confirmed that the batches of milk powder brand Blédilait products on the same production line as powdered milk brand Picot were the cause of cases of this second phase.

On 7 April, the company was implementing Blédina the withdrawal of marketing and recall of these lots:

• Gallia 2: 450g - Dec 06 - Lot: 1210/BLJ
• Gallia 2: 900g - Dec 06 - Lot 1211/BLK
• Blédilait 2: 450g - Dec 06 - Lots: 1210/BLJ and 1229/BL7
• Blédilait 2: 900g - Dec 06 - Lots: 1221/BLX, and 1229/BL7 1231/BL9

In total, 69 infants sick after consuming milk powder brand Blédilait have been identified to date.
These children have symptoms of salmonellosis between March 21 and April 21, 2005. Among them, 3 children sick on March 31, April 10 and April 21 had consumed milk powder batches belonging to Blédilait 2 JAN07 290 DNH (2 cases) and 289 JAN07 DNH (1 case) not been produced in the facility producer of powdered milk Picot.
An investigation into the group's factory Blédina where these lots were made showed that they had been conditioned in this factory, just after lots and 1229/BL7 1231/BL9, produced by the facility producer of powdered milk Picot brand on the same packaging line.

On 29 April, the company has Blédina implemented the withdrawal of the marketing of these lots:

• Blédilait 2: 900g - JAN07 - Lot: 289/DNH
• Blédilait 2: 900g - JAN07 - Lot: 290/DNH

InVS, in collaboration with the NRC for Salmonella, is continuing its investigations to ensure the effectiveness of these measures.

Reminders on Salmonella

Salmonella infections occur within three days after eating a contaminated product and cause an array of gastroenteritis with vomiting, sometimes bloody diarrhea, and fever in most cases. The appearance of these signs in an infant should lead families to seek medical attention.

Salmonella Agona is part of the 2,000 Salmonella serotypes pathogenic to man. From 2000 to 2004, CNR Salmonella has identified about a hundred strains of human Salmonella Agona year. Like most other serotypes of Salmonella serotype Agona is found in France in various reservoirs including poultry, cattle, pigs and cattle feed [1].

Four outbreaks of Salmonella Agona has been reported before in other countries, including one attributed to the consumption of milk powder [2]. The other 3 were due to consumption of herbal teas containing fennel and anise [3], snack peanut [4], and oat-based cereals [3].

References

1. Brisabois A, Fremy S, Gauchard F, et al. Inventory of Salmonella 2002. French Agency for Food Safety, June 2004
2. From the Centers for Disease Control and Prevention. Multistate outbreak of Salmonella serotype Agona infections linked to toasted oats cereal - United States, April-May, 1998. JAMA. 1998; 280 (5): 411
3. Koch J, Schrauder A, Werber D, Alpers K, Rabsch W, Prager R, Broll S, Frank C, Roggentin P Tschäpe H, Ammon A and K. Stark A nation-wide outbreak of Salmonella Agona in infants due to Aniseed in herbal tea, Germany, October 2002-July 2003. 5th World Congress Foodborne Infections and intoxications, 7-11 June 2004, Berlin, Germany
4. Killalea D, Ward LR, Roberts D, et al. International Epidemiological and Microbiological study of outbreak of Salmonella Agona infection from a ready to eat savory snack - I: England and Wales and the United States. BMJ 1996; 311-13

this document also states why the UK Food Standards Agency has adopted the EU guideline.

There is another thread on this forum about making up bottles in advance and storing in the fridge - someone helpfully posted a link to a WHO leaflet that gives guidance on doing this (would try and find this thread, but can hear baby stirring, must get off...!)

Foxtytoxin so, from the lengthy stuff you cite, which I admit I have not read in full, there appears to be nothing about how these parents prepared their Picot milk; it was the milk itself that was the problem?

Of course, leaving children unsecured in cars is bloody stupid, whether or not we survived it ourselves or not.

But that not my argument. My point is that there seems to be considerable concern about 'risks' which when analysed are vanishingly small. And I wonder how much greater risk is created by confusing and worrying parents with endless guidelines that seem to change from one month to the next.

It would be rather horrible if we do discover that our great adherence to hygiene is in fact responsible for more and more children suffering astham and allergies. There does appear to be a correlation.

Spero It was in the Daily Mail: here.

The problem is that the bugs are present in the powdered formula. V hot water is needed to kill them, so the formula itself is the problem, but preparing it properly as per the DH guidance removes that risk.

Small risk (likelihood of it happening), huge hazard (based on potential harm).

Risk exposure is calculated based on 2 factors - likelihood of risk occurring and potential harm caused. The risk exposure here is exceedingly high because potential harm is death or serious disability.

This risk can be reduced by taking precautions.

It was a fault in the preparation if the milk - had it been made with hot enough water the bacteria would have been killed or at least brought down to insufficient levels to colonise and cause an infection, a precaution which reduces risk exposure and brings the risks associated with using formula down to acceptable levels.

spero is there any evidence that exposure to bacteria reduces risk of allergys? (i thought it was pollen, animal hairs and parasites?) There is still bacteria in formula made correctly any way. As frankenstine says they are just reduced to acceptable numbers. So a baby would still be getting exposure if this were bennefitial. I'm sure that if there was any evidence on this it was factored in to the who's analysis.

On the subject of ever changing guidance iirc tiktok said that this change (five years ago) is the only one there has been in ages (if not forever) on the subject of formula preparation... Sorry if inaccurate!

If i was cooking chicken for myself i wouldn't skimp on cooking to save time, as there is a risk that there could be salmonella in the flesh. And i am a healthy adult with a fully developed immune system, and it would be ME exposed to the risk rather than someone else (a baby)

I do not understand the resistance to making formula with hot water rather than cold. It's not a civil liberties issue! [hconfused]

We used ready made cartons during night and had bottle warmer and sterilised bottle on bedside table. Didnt even get out of bed to feed.

Also stored milk in fridge for all 3.

The Daily Mail article does not support what was being put forward: that babies had died in Europe. IT says the risk is to premature babies; that was not made clear.

When stories like this get exaggerated, people like me switch off. And that is dangerous because of course it is an important issue. But we all draw from our own experiences, because that does inform our appreciation of risk.

I worry that the pendulum has swung too far by insisting on extremely high standards which I think often have the perverse effect of making people less likely to meet even lower standards.

I have had clients fail parenting assessments initiated by social services because at the residential unit they are told they must not use a bottle after one hour, the HV says something different, they start waiting until the baby cries to make up formula and then get criticised for that.

Bloody hell. Exhausted reading all this. And people think ff is easy - compared to all this, bf is a doddle.

I think the risk was perceived to be to premature babies, until a full term baby died (in Iceland).

i have always

poured the boiling water into bottles.

let them cool

added formula powder to the water as required.

Shake it up and feed.

Make sure it is discarded after one hour.

Is this safe?

If I add the powder to the cooled boiled water and use immediately, or within an hour, would this not eliminate the growth of bacteria due to the lack of time? )sorry tired, inarticulate a bit !)

Spero, I quote from the DM article:

"Last year, an infant died in Belgium after being given milk powder that carried E sakazakii. Deaths have also been reported in the Netherlands, the U.S. and Canada.

A U.S. study in 2002 found E sakazakii in 14 per cent of formula milk. The authors of the Dutch study, funded by Nestle, have not revealed the locations of the factories they investigated or what products might be affected."

This part is not about premmies, though the way the article is written I can see how you might think it was. If you read it carefully you will see that it isn't.

But seriously, you would take the DM's word over the health authorities whose info has been linked to above ?

onedge the reason for mixing the formula powder with water not less than 70 degrees is that the powder isn't sterile. The hot water would kill any bugs. Using cooled boiled water to make up a feed doesn't have the same effect.
The main risk is to premature babies, those who are immune suppressed, and according to the fsa/doh I think, also newborns - risk being related there to the potential impact on health rather than risk of catching the bugs.

The health advise link foxytocin posted covers all bases re safe preparation/going out/childcare/milk storage and so on..

To add to why it isnt safe to use cool water - even tiny levels of the bacteria, such as those found in a small amount of contaminated powder, can cause infection in a baby. The level needs to be brought down further with hot water.

This bug is dangerous because it's extremely virulent, survives digestion and colonises quickly. So you can use the milk instantly but it's going into a baby, who's at the perfect temp for incubating it plus a fairly reliable source of food, and staying there for a couple of days whereas many bugs would be dealt with by the digestive system.

The risk of death is highest in preemie, immunosuppressed and newborn babies but full-term babie s have died, and death is the most severe but not the only consequence. A baby at my church got infected and is disabled quite severely, and will be for life. It's not something I personally want to risk a baby catching as very few make a complete recovery.

Why is it harder to mix the powder with hot water then top up with cooled boiled water vs mix with cooled boiled water? Why is that considered so excessive and onerous?

I had a premmie and i was told to make up the bottlesby boiling kettle, leaving water to cool for half hour then adding formula and feeding. There was no mention of adding powder in while the water was still very hot. We swiftly moved to boiling the kettle at the end of one feed and using the water at the next feed to make up the milk and then just microwaving it a bit to warm it up a little..... Also if I was going out I was told to take pre boiled water in a bottle and add formula to the water when we were ready to use it. The emphasis was on keeping the water and formula separate until about to be used. As another poster has said isn't it partly about the time factor for the organism to grow as well? I was expressly told NOT to put made up bottles in the fridge to use later. I'm not disputing any of the advice given here, just saying that's what the largest regional neonatal unit told me to do in 2007. Now I think did I put my ds's life at risk every time I fed him? Ironically enough he's never had d/v bug as far as I've been able to tell, seems to have guts of steel so maybe that's stood him in good stead.

spero - guidelines don't change often. The current guidance on how to make up formula safely is the first time things have changed vis a vis bottle feeding in at least 30 years. I agree there is confusion - that's because some HCPs, maternity units and neonatal units are telling parents something different, and because some parents do what their own mothers did, or what they did with previous children.

The 'hygiene hypothesis' which you refer to - the idea that homes are possibly 'too clean' these days - has nothing to do with safe formula preparation, which is designed to protect the health of very young babies whose immune system does not have the protection of breastfeeding. No one sensible would suggest there is anything protective about deliberately exposing new babies to salmonella (which can cause very unpleasant D&V and in rare cases has a long-lasting effect) or enterobacter S. (which also causes D&V and in rare cases, death).

I too don't understand the resistance to this. The guidance is evidence-based, and not terribly arduous to comply with, and on the occasions when it is too difficult to do, there is ready-to-feed from the carton. When babies get older, it's fine to relax the standards a bit.

But people get very defensive - as if you can somehow be too careful with the health of a young baby.

Iggybuff -if you mix powder with hot water and then top up with cold you will end up with the wrong volume. Adding the powder alters the volume of the hot water. To be sure you are using the correct volume of water, you would need to measure each volume of water before mixing either with powder.

Brolly So you could measure out the volume of hot water first?