Formula case 'may not have been first'

Health officials say they were unaware of a New Zealand case 14 years ago where twins contracted meningitis - an infection which has since been linked to powdered infant milk formula.

The Herald reported yesterday that the Ministry of Health failed to pass on American warnings in 2002 about the dangers of powdered milk formula for premature babies. That was two years before a Waikato baby died from an infection linked to infant formula.

Linnea Jones-Baillie died in the neo-natal intensive care unit at Waikato Hospital in July from Enterobacter sakazakii meningitis. Her death was believed to be the first in New Zealand from the bacterium.

The Ministry of Health is now investigating the case of twins who contracted E.sakazakii meningitis in the neo-natal unit at National Women's Hospital in Auckland after they were born in March 1991.

The twins, who were born prematurely by caesarean section, were nursed in incubators and fed by tube and bottle with powdered formula.

Both developed meningitis and while one of the girls responded well to antibiotics, the other suffered complications resulting in serious brain damage and spastic quadriplegia.

The girls' mother fought for compensation from ACC, claiming her daughter suffered personal injury by medical misadventure after being exposed to the meningitis while in the hospital's care.

A District Court decision, printed in The Herald in September 1998, said the cause of the infection could not be ascertained.

Professor Diana Lennon, who studied the international literature, said "the evidence, although inconclusive, tilts towards formula as a possible vehicle for this infection".

After a lengthy appeals process the girl was awarded $800.

Yesterday the ministry's Director of Public Health, Dr Mark Jacobs, said after Linnea's death the ministry had sought information from paediatricians around the country about other cases.

There had been a suggestion of a case in Auckland but no records were found. Ministry staff were now seeking information from ACC and the National Women's Hospital.

The ministry did not pass on American warnings in 2002 against using powdered infant formula because it understood there had been no cases reported here, the risk of infection was small and the product implicated in the American death was not available in New Zealand.

Dr Jacobs did not believe in the early 1990s there was any indication anywhere in the world that formula could be connected to meningitis.

Soon after Linnea's death, the ministry issued advice to hospitals that where breast milk was not available, neo-natal units should use ready-made liquid formula, which was sterilised in the bottle.

Dr Jacobs said the discovery of the earlier cases was surprising and emphasised the importance of making the meningitis caused by E.sakazakii notifiable.

Professor Diana Lennon, who studied the international literature on E.sakazakii, said in hindsight it might have been best if the type of infant formula used in neo-natal units had been reviewed at the time.

But she said that was not necessarily the ministry's job. "It's not a cover up. It's rare."

A National Women's Hospital spokeswoman said the neo-natal unit had used ready-made formula for "some years".

Formula risk

* About 50 cases of Enterobacter sakazakii infection have been reported internationally in the past 40 years.

* Most cases were among premature or low birth weight babies. Doctors say the risk of healthy babies getting sick from the bacterium is remote.

* The E.sakazakii bacterium has been found in powdered infant formula, which is pasteurised but not sterilised because sterilisation removes key ingredients needed for development.

* The Ministry of Health recommends parents prepare formula immediately before feeding and only the amount needed for the baby's feed.

* Powdered formula should be kept covered in a clean, dry place and used within four weeks of opening the tin.