TOPIC CRONOBACTER INFECTIONS LINKED TO POWDERED INFANT FORMULA

HO CHI MINH CITY UNIVERSITY OF TECHNOLOGY AND EDUCATION FACULTY OF CHEMICAL AND FOOD TECHNOLOGY SUBJECT: FOOD SAFETY TOPIC: CRONOBACTER INFECTIONS LINKED TO POWDERED INFANT FORMULA Instructor: Dr Trương Quang Bình Group’s Member: HO CHI MINH CITY, JUNE 2022 MEMBER’S WORK Member’s name Nguyễn Trần Hoàng Anh (Leader) Trần Tiểu Phụng Nguyễn Thị Quỳnh Trân Nguyễn Hoàng Hồng Thắm Table of Contents Introduction Overview of Powdered infant formula 2.1 Powdered infant formula 2.2 Processing of powdered infant formula 2.2.1 Preparation of the mix: 2.2.2 Homogenisation and emulsification: 2.2.3 Heat treatment: 2.2.4 Evaporation: 2.2.5 Spray drying: 2.2.6 Packaging: 10 Cronobacter illnesses linked powdered infant formula 10 3.1 Cronobacter sakazakii 10 3.2 Some reported cases of Cronobacter spp infections related to powdered infant formula (PIF) 16 Reasons for the Cronobacter infection in powdered infant formula 25 Recommended solutions 28 5.1 Control in manufacturing environment 29 5.1.1 Biocides to control Cronobacter 29 5.1.2 Essential oils 31 5.1.3 Polyphenols 32 5.1.4 Prebiotics 33 5.1.5 Risk analysis 33 5.2 Control in the home 37 5.2.1 Reducing the level of contamination through heating reconstituted PIF prior to use 37 5.2.2 Minimizing the chance of contamination of reconstituted formula during preparation 37 5.2.3 Minimizing the growth of C sakazakii following reconstitution prior to consumption 38 5.2.4 Guidelines from Centers for Disease Control and Prevention - U.S Department of Health & Human Services 38 Conclusion 42 References 45 Introduction Breastfeeding of young newborns is undeniably preferable to ensure a healthy child's development Nevertheless, it is not always feasible to breastfeed Powdered infant formula (PIF) is designed to be a supplement to breast milk and can be used as a substitute if mothers are unable to breastfeed their children[1] PIF is a low water activity non-sterile product Therefore, it might contain a range of bacteria that can grow rapidly following reconstitution[2] Cronobacter spp (formerly Enterobacter sakazakii) is one of the most concerns in powdered infant formula The Cronobacter spp infections cause neonatal meningitis or necrotizing enterocolitis and bacteremia, which results in an alarming mortality rate has been reported [3] Many cases of Cronobacter spp infections have been researched that is linked epidemiologically to powdered infant formula (PIF) [4] Cronobacter infections are uncommon, but they can be fatal to neonates Although the amount of Cronobacter sakazakii has been found only cfu/g in powdered infant formula [5], time-temperature abuse of prepared formula allows modest quantities of pollutants to rise, potentially causing illness Low populations, on the other hand, have been found to induce sickness even in the absence of abuse after preparation [6] According to FAO/WHO in 2008 [7], there were at least 120 reported cases of neonatal and infant Cronobacter spp infections and 27 fatalities worldwide This might be an underestimation due to unreported and misidentified instances [2] [8] In particular, most recently, in 2022, there were cases of Cronobacter illness with deaths believed to be linked to powdered milk When the source of the infection was thought to be related to Abbott's powdered infant formula, the incident became even more concerning Furthermore, the FDA's recently disclosed inspection results document detailing a pattern of deficiencies with food safety procedures at Abbott's infant formula production plant raises the question of whether the manufacturing process of this factory causes Cronobacter infections Considering the high risk of Cronobacter infections in formula milk as well as recent infections due to intrinsic contamination or through extrinsic contamination, our team decided to choose the topic: Cronobacter Infections Linked to Powdered Infant Formula with the desire to better understand Cronobacter spp., the causes of infection, and as well as offer recommended solutions to limit the risk of infection Overview of Powdered infant formula 2.1 Powdered infant formula [9] The term "powdered infant formula" refers to a variety of products, including both breast milk fortifiers and breast milk substitutes The former are nutritional supplements added to breast milk, which may not be sufficiently nutritious for the baby if the baby was born prematurely In general, the term