Cronobacter Infection and Infants

Cronobacter infections are often reported among infants who have been fed powdered infant formula.

Getting sick from Cronobacter does not happen often, but infections in infants can be deadly. Cronobacter infections in infants less than 12 months old are often linked to powdered infant formula. If your baby is fed with powdered infant formula, you can take steps to protect your baby from sickness.

Cronobacter sakazakii is a germ found naturally in the environment.

These germs can live in dry foods, such as:

• Powdered infant formula
• Powdered milk
• Herbal teas
• Starches

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 two to four cases are reported to CDC every year, but this figure may not reflect the true number of illnesses. That’s because most hospitals and laboratories are not required to report Cronobacter infections to health departments.

Cronobacter germs can cause a dangerous blood infection (sepsis). They can also make the linings surrounding the brain and spinal cord swell (meningitis).

Infants who are more likely to get sick include:

• Infants 2 months and younger. These infants are most likely to develop meningitis if they get sick from Cronobacter.
• Infants born prematurely.
• Infants with weakened immune systems. Babies with this condition can’t fight germs as well because of illness or medical treatment, such as chemotherapy for cancer.

Cronobacter illness in infants will usually start with a fever and poor feeding, excessive crying, or very low energy.  Some infants may also have seizures. You should take an infant with these symptoms to a medical provider as soon as possible.

Cronobacter infection can also be serious for:

• People 65 years and older.
• People who have immune systems weakened due to illnesses or conditions, such as HIV, organ transplants, or cancer.

Follow These Five Guidelines to Protect Your Baby From Cronobacter

You may want to take extra precautions if your baby is younger than 2 months old, was born prematurely, or has a weakened immune system:

Wash your hands with soap and water, especially before preparing bottles and feeding your baby.

1. Breastfeed if you can. Breastfeeding is one of the best things you can do for your baby’s health and development. Health officials and medical providers report very few cases of Cronobacter infection in infants fed only breast milk.

2. Clean, sanitize, and store feeding items such as baby bottles and breast pump parts safely. Help prevent germs from growing on these items and keep your baby’s milk safe. You can do this by carefully cleaning, sanitizing, and storing bottles and breast pump parts. Take apart bottles and breast pump equipment after use for thorough cleaning.

3. Keep hands clean! Always wash your hands with soap and water for at least 20 seconds during key times:

• Before preparing and feeding bottles or food 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 a hand sanitizer with at least 60% alcohol. Check the product label to be sure. Wash hands with soap and water as soon as possible after using hand sanitizer. Hand sanitizer with at least 60% alcohol kills Cronobacter. But hand sanitizer does not kill all types of germs. It may not work as well if hands are visibly greasy or dirty.

4. If you feed your baby with formula, consider using liquid formula when possible. Powdered infant formula is not sterile and might have germs in it. Using a liquid formula instead of powdered is especially important if your baby:

• Is less than 2 months old
• Was born prematurely, or
• Has a weakened immune system.

Liquid infant formula is made to be sterile (without germs). This means liquid formula should not make your baby sick with Cronobacter infection when you follow the instructions on the container.

You do not need to warm infant formula before feeding, but some people like to warm their baby’s bottle. If you do 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 it under warm running water. Keep the running 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.

Keep all surfaces and feeding items clean when preparing infant formula. This includes all countertops, feeding items (nipples, caps, rings, valves), and objects that may enter the baby’s mouth, such as pacifiers and teethers.

5. Prepare and store powdered infant formula safely. Make sure that your formula is not expired or recalled. The container should be in good condition with no dents, puffy ends, or rust spots. Keep powdered formula lids and scoops clean. Close containers of formula as soon as possible.

In most cases, it is safe to mix powdered infant formula following manufacturer’s instructions on the container. But, if your baby may be at higher risk, consider taking these extra steps to prepare your powdered formula with hot water (at least 158°F/70°C):

1. Clean work surfaces, such as countertops and sinks, with soap and water, or use a disinfectant wipe or paper towel sprayed with cleaning product. Do not place feeding items directly in the sink, because germs in sinks or drains could contaminate these items.
2. Wash hands with soap and water before preparing infant formula.
3. Boil water and let it cool for about 5 minutes.
4. Pour the water into a clean bottle or feeding cup.
5. Add the exact amount of formula listed on the container.
6. Carefully shake the capped bottle rather than stirring the mixture.
7. If you plan to use the prepared formula right away, 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.
8. 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 start feeding your baby with the prepared formula right away, put it in the refrigerator immediately. Use formula in the refrigerator within 24 hours. Throw out formula if you can’t remember how long you have kept it in the refrigerator.  Do not feed it to your baby. For more information, visit CDC’s Infant Formula Preparation and Storage webpage.