Cronobacter Infection and Infants
Getting sick from Cronobacter does not happen often, but infections in infants can be deadly. Learn what steps you can take to protect your baby from getting sick.
Cronobacter sakazakii, formerly known as Enterobacter sakazakii, is a germ found naturally in the environment. The germs can live in dry foods, such as powdered infant formula, powdered milk, herbal teas, and starches. Cronobacter can cause diarrhea and urinary tract infections in people of all ages, but infection can be very serious in infants.
Rare but Serious Illness in Infants
Cronobacter infections are rare, but they can be deadly in newborns. Infections in infants usually occur in the first days or weeks of life. About four to six cases are reported to CDC every year, but this figure may not reflect the true number of illnesses because most hospitals and laboratories are not required to report Cronobacter infections to health departments.
Cronobacter germs can cause a dangerous blood infection (sepsis) or make the linings surrounding the brain and spinal cord swell (meningitis). Infants 2 months of age and younger are most likely to develop meningitis if they get sick from Cronobacter. Other infants more likely to get sick are those born prematurely and those less able to fight germs and sickness because of illness or medical treatment, such as infants receiving chemotherapy for cancer.
The first symptom of Cronobacter infection in infants is usually a fever, accompanied by poor feeding, crying, or very low energy. You should take an infant with these symptoms to the doctor.
Follow These Five Guidelines to Protect Your Baby From Cronobacter
1. Breastfeed. Breastfeeding is one of the best things you can do for your baby’s health and development. Among its benefits: preventing different kinds of infections, such as ear and respiratory infections. Very few cases of Cronobacter infections have been reported among infants fed only breast milk.
2. Clean, sanitize, and store feeding items and breast pump parts safely. You can help prevent contamination with germs and keep the milk you feed your baby safe by carefully cleaning, sanitizing, and storing:
- Baby bottles
- Other feeding items
- Breast pump parts
Breastfeeding helps prevent many kinds of sicknesses among infants.
3. Consider using liquid formula when possible. If your baby gets formula, consider using formula sold as a liquid rather than a powder. This is especially important when your baby is less than 3 months old or if your baby was born prematurely or has a weakened immune system. Liquid infant formula is made to be sterile (without germs) and should not transmit Cronobacter infection when handled carefully. Powdered formula is not sterile.
Infant formula does not need to be warmed before feeding, but some people like to warm their baby’s bottle. If you do decide to warm the bottle, never use a microwave. Microwaves heat milk and food unevenly, resulting in “hot spots” that can burn your baby’s mouth and throat.
- To warm a bottle, place the bottle under warm running water, taking care to keep the water from getting into the bottle or on the nipple. Put a couple drops of infant formula on the inside of your wrist to make sure it is not too hot.
4. Prepare and store powdered infant formula safely. Make sure that your formula is not expired and that the container is in good condition. Keep powdered formula lids and scoops clean, and close containers of formula as soon as possible. In most cases, it is safe to mix powdered infant formula following manufacturer’s instructions. But if your baby is less than 3 months old, was born prematurely, or has a weakened immune system, you may want to take the following extra steps to protect against Cronobacter:
If your baby is fed with powdered infant formula, there are things you can do to protect your baby from sickness.
- Clean work surfaces, such as countertops and sinks.
- Boil water and let it cool to no less than 158°F/70°C before pouring it into a clean and sterilized feeding cup with a lid, or into a bottle. Water should cool to this temperature within 30 minutes after boiling.
- Add the exact amount of formula listed on the container, and carefully shake the bottle rather than stirring the mixture.
- Immediately cool the formula to body temperature to ensure it is not too hot before feeding your baby. Run the prepared, capped bottle under cool water or place it into an ice bath. Do not let the cooling water get into the bottle or on the nipple.
- Before feeding the baby, test the formula’s temperature by putting a few drops on the inside of your wrist. It should feel warm, not hot.
Use prepared infant formula within 1 hour from start of feeding and within 2 hours of preparing it. If your baby does not finish the entire bottle of formula, throw away leftover formula. If you do not plan to use the prepared formula right away, refrigerate it immediately. Use refrigerated formula within 24 hours. 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.
5. Keep hands clean! Always wash your hands carefully with soap and water during key times:
- Before preparing and feeding bottles or foods to your baby.
- Before touching your baby’s mouth.
- Before touching pacifiers or other things that go into your baby’s mouth.
- After using the toilet or changing diapers.
If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol (check the product label to be sure). Hand sanitizer with at least 60% alcohol kills Cronobacter germs, but wash with soap and water as soon as possible after using hand sanitizer. That’s because hand sanitizer does not kill all types of germs, and it may not work as well if hands are visibly greasy or dirty. It’s also important to keep all objects clean that may enter the baby’s mouth (such as pacifiers and teethers).
Wash your hands carefully with soap and water, especially after using the toilet or changing diapers.
Food Safety and Handwashing:
- WHO: Safe preparation, storage, and handling of powdered infant formula guidelines pdf icon[PDF – 32 pages]external icon
- Foodsafety.gov: People at Risk: Children Under Fiveexternal icon
- Handwashing: Clean Hands Save Lives
- Disaster Planning: Infant and Child Feeding
- Printable Fact Sheet: How to Keep Your Breast Pump Kit Clean pages] [English pdf icon[PDF – 2 pages] and Spanish pdf icon[PDF – 2 pages]]
- Proper Storage and Preparation of Breast Milk
Infant Formula Feeding: