Question about formula for premature babies

[tabouleh]

Hello - I hope you don't mind me intruding into your topic.

I am trying to raise awareness about safe preparation of infant formula.

I often pop up on the BF/FF boards because when BFing went wrong for me I was shocked to learn that formula powder is not sterile and can contain nasty bacteria.

The guidelines for safe preparation of formula are not widely followed or understood or explained by health care professionals etc.

I am aware that premature babies are at the greatest risk from such infections so that's my reason for starting this thread.

I was wondering whether your premature babies when they were in hospital were they feed with ready to feed liquid formula. If so then that product is sterile.

If not then were you aware of how the formula was made up?

The WHO recommendations adopted in the UK are to make formula up with 70 degree water.

I am aware that some special formulas cannot be made with water that temperature and for them they should be made and fed immediately and I believe that the manufacturing process is meant to be more hygienic.

I'm not medically qualified or anything and I don't want you to take anything I say and change things without discussing with your doctors etc - I just want to make sure that parents of premature babies have info about this.

Here are some links:

DOH/FSA guidelines for HCPs

WHO guidelines.

Irish Guidance Note 22 - very useful document.

Hi

First I would say be very careful when discussing anything with mothers of premature babies, at least as far as i am concerned I have found a number of things said to me, however well meaning to be offensive or ill thought out. I know that that is likely to have been me, and the space I was in at the time but it is very hard having a premature baby. You are told countless things by countless people, many of which are contradictory. Another voice may not always help.

Secondly i would say that it is very hard for the medical staff when dealing with formula, and NHS rules do not always help them do their jobs. For example they are not allowed in my local hospital to have any formula out apart from when they are just about to feed it to the babies as they are supposed to be encouraging breastfeeding. Given I am the only mum I actually know who was discharged with a fully breastfed baby, at least of the mums who were in nicu and scbu with me that is a bit silly.

Coming on to your questions, all the babies who were given formula in my hospital were given it as prepared cartons/bottles regardless of the formulas used. Often the mums would not themselves be responsible for that it would just appear. Sometimes even preprepared formula is fortified and that took place in the milk kitchen. The woman who ran that kitchen had 30 + years of experience of dealing with milks for prems, and woe betide anyone (even the consultants) who ever sought to question her.

Once you were being prepared for going home you took more responsibility for feeding etc, but were still given the preprepared formula. Often when mums were discharged they were also sent home with a stock of formula from the hospital pharamcy.

As part of the discharged your GP was sent a letter which was about the formula requesting that preprepared formula was presctibed for the baby until it was 4 weeks corrected age. After which you get the formula as powder - although many GPs will in fact still prescribe the prepared stuff.

I can't comment much on the other information, although I was given printed info on bottle feeding I never read it. I do however know that my hospital would never discharged anyone unless they were happy they knew what they were doing. And that includes things far more dangerous than giving formula. And they are very scrupulous about sterilising so I sterilise syringes daily in milton but everything esle (breast pump etc) in a steriliser as there may be a long term risk of milton, but its better for syringes which are smaller etc.

hildathebuilder - I can totally understand the sensitivity regarding discussing these matters with parents with premature babies.

My heart goes out to you all. I have no idea what you've all been through/are going through.

I am hoping that someone may be able to confirm that in the UK the NHS does indeed either use ready to feed liquid or adhere to the World Health Organisation guidelines.

Maybe someone posting here whose baby is a bit older and who has more time will be able to campaign on this issue.

Your comment re the lady running the milk kitchen doesn't sound great.

E. Sakazakii blog has more info.

In both the hospitals my LO was in, formula was in ready to feed sterile bottles. Do you have any particular reason to believe that guidelines aren't being followed? I'm the first to call for a campaign when things are being done wrongly, but my impression is really that that safe feeding practices are followed to the letter in neonatal units.

And as Hilda said, infection control more generally is really something which neonatal units take extraordinarily seriously. I think you can rest easy that of all the things parents of premature babies have to worry about, safe formula preparation is the very least of them!

"Do you have any particular reason to believe that guidelines aren't being followed?" - I don't have any evidence wrt to premature babies but for full term new borns midwives and hvs do not explain the guidelines and the safe alternatives to making fresh each time.

I would hope that as you say in all cases the formula in hospital is ready to feed or made to order within the guidelines and that on discharge all parents have the guidelines and the reasons for them fully explained to them.

At the hospital I was in the formula was in ready prepared plastic bottles and stored in the fridge - then warmed up by putting a measured amount in another sterile container (they were all wrapped in plastic) in a bowl of hot water.

For those like me who were trying to get their own milk going, in the pumping room, every woman was given her own attachment to the hospital pump and a tank and a supply of milton tablets. We were instructed to change the water/tab every 24 hours and had a sticker on top of the tank where we wrote the date + time of the last water change. We washed our attachments out in a sink of hot water. There were sterile bottles supplied for our milk and we put it in the same fridge as the formula (everyone had a separate cardboard tray in the fridge).