A spoonful of milk powder caused intestinal necrosis in a baby girl? Learn how to prepare milk powder for babies in one article

Real points:

For premature infants, feeding with formula milk does increase the risk of neonatal necrotizing enterocolitis, which is related to the poor digestion and absorption of formula milk by premature infants. However, there is no authoritative literature indicating that this is caused by the excessive concentration of formula milk.

Verified by: Wang Ping | Pediatrician at Zhuozheng Medical

Recently, an article titled "Heartbroken! Dad scooped an extra spoonful of milk powder, causing the baby's intestinal necrosis!" was circulated on the Internet. The article tells such an incident: In order to make his baby eat more and grow faster, a new father added an extra spoonful of milk powder every time he prepared milk, which eventually caused the baby's intestinal necrosis and almost endangered his life.

1. The incident has been circulating for a long time, and the baby girl in the incident was a premature baby

This story may scare a lot of new parents, but to be honest, when making milk powder for the baby, anyone may suddenly shake their hands, a little more or a little less. Can an extra spoonful of milk powder really cause intestinal necrosis in babies? To discuss this issue, we must first start with the little protagonist of this article, "Duoduo".

The original article did not clearly state Duoduo's specific condition, but only said that after she drank her father's formula milk, she gradually developed symptoms of abdominal distension, vomiting, and a hard stomach. She was sent to the hospital for examination, and it was found that 35 cm of her small intestine had turned black and necrotic, and had to be removed in time. Then there was a summary: The newborn's intestine has very limited tolerance to osmotic pressure, so concentrated milk powder will cause intestinal necrosis. It sounds reasonable.

The author used "a spoonful of milk powder" as a keyword to search and found that from 2016 to 2020, Duoduo's story has been told in WeChat Moments for four years, and many of them are accompanied by videos. In the video screenshots, we can see that the baby named Duoduo is skinny. Anyone who has been a parent will doubt at first sight, is this baby really full-term?

Sure enough, after searching for relevant reports, it was discovered that Duoduo was actually a premature baby. According to the surgeon who performed the surgery, Duoduo was born at 28 weeks, was underdeveloped, and was thin.

Screenshot of Wenzhou Metropolis Daily report on October 16, 2016

The problem is clearer now. The "intestinal necrosis" mentioned in the video is actually "neonatal necrotizing enterocolitis", a disease that is more common in premature infants. The incidence ratio of premature infants to full-term infants is about 9:1, which means that only 10% of patients with neonatal necrotizing enterocolitis are full-term babies, and the rest are premature babies. The incidence rate will gradually decrease with the increase of the baby's gestational age.

As for the pathogenesis of "neonatal necrotizing enterocolitis", the pathogenesis of full-term infants is still unclear. Generally, full-term infants who develop neonatal necrotizing enterocolitis have other underlying diseases, which lead to mesenteric hypoxia. At the same time, non-breastfeeding, that is, formula feeding, will also increase the risk of disease, but there is currently no authoritative literature to determine the corresponding causes.

2. The root cause of the girl's intestinal necrosis may not be excessive concentration of milk powder

There are many reasons why premature infants develop "neonatal necrotizing enterocolitis", such as immature intestinal and immune systems, damaged intestinal mucosal barriers and microcirculation, unstable circulation, inflammatory response, etc. According to case observations, for premature infants, feeding with formula milk does increase the risk of neonatal necrotizing enterocolitis, but so far, no authoritative literature has pointed out that this is caused by excessively high concentrations of formula milk. Rather, it is because premature infants have weak digestion and absorption capacity for formula milk, resulting in incompletely digested carbohydrates and lipids, which will be fermented by intestinal bacteria to produce reducing substances, organic acids, short-chain fatty acids, carbon dioxide, hydrogen and other products, which may cause damage to the baby's mucosa, thereby inducing or aggravating neonatal necrotizing enterocolitis.

Moreover, for formula-fed infants who have been diagnosed with poor weight gain, it is usually recommended to add less water to infant formula, or add concentrated formula, monomer nutritional supplements, etc. to increase the caloric density under the guidance of professional doctors, in order to achieve the purpose of promoting weight catch-up growth. However, it should be noted that increasing the caloric density will also cause the osmotic pressure of the formula to rise, which may also cause diarrhea or malabsorption in infants. If the monomer nutritional supplement is not added properly, it may induce ketosis due to the change in the nutrient ratio of the formula, and even affect the baby's life safety. Therefore, when making adjustments, it must be done under the guidance of professional doctors and professional nutritionists, and never add it on your own.

I think everyone has understood that Duoduo’s “intestinal necrosis” may not be caused by the concentration of milk powder. It’s just that when we cannot find a definite cause, having a plausible reason always seems to make people feel more at ease.

3. How should you prepare milk for your baby?

I have said so much to comfort parents who occasionally slip when preparing milk, but I do not want you to slip a few spoonfuls every time. Why do I emphasize this so much? Because many parents have the habit of either left or right. In order to prevent everyone from involuntarily "adding quantity without adding water" every time they prepare milk for their babies from today, we still want to emphasize the key points that must be paid attention to when preparing formula milk.

1. Prepare the formula milk according to the ratio specified in the instructions.

I think everyone must have heard the saying: "Breast milk is the best, formula is good enough." So, how is formula "good enough"? It depends on its imitation of the composition and proportion of nutrients in breast milk. In other words, the better the formula, the closer it is to breast milk.

Then, when you artificially change the mixing ratio of formula milk, the formula milk will become less and less similar to breast milk. In order to preserve the love of both mother and father, you must carefully follow the instructions on the milk powder, add water first and then powder, and never add more or less.

2. Don’t use water too low for making milk

Regarding the water temperature used for making milk, the recommendations on many milk powder cans are not consistent. Some recommend around 40°C, while others recommend 70°C or even higher. This often leaves parents confused. At what temperature in Celsius should water be used to make milk?

In order to prevent bacterial infection, especially Cronobacter sakazakii infection, the World Health Organization, the U.S. Centers for Disease Control and Prevention, the Hong Kong Department of Health and other institutions all recommend using water at a temperature of no less than 70°C to prepare formula milk, which can effectively kill any Cronobacter sakazakii in the milk powder. However, even so, it is recommended to shorten the interval between the time of preparing formula milk and the time of the baby drinking milk as much as possible. If the prepared formula milk has been left at room temperature for more than 2 hours, it is recommended to discard it in time.

3. It is really unnecessary to use "baby water" to make milk

Regarding the water used to prepare milk powder, the World Health Organization and the Food and Agriculture Organization of the United Nations only used a very short sentence - "boiled sufficient safe drinking water." In other words, as long as it is drinking water that meets national standards (such as tap water), it is fine after being thoroughly boiled.

"Distilled water" and "purified water" can also be used to make milk powder, especially when you are out and there is no definite safe water source; as for mineral water, because of its high mineral content, it is not suitable for long-term use in making milk powder.

Editor of this article: ambergchen