A premature infant was reported to the Iowa Department of Public Health as having Enterobacter sakazakii infection. Premature and low birth weight infants are susceptible to this infection. A link between illness and consumption of powdered infant formula had already been established. The infant was hospitalized for nearly five months, suffering multiple complications of E. sakazakii infection – seizures, respiratory distress, diabetes insipidus, and others. He underwent multiple surgeries for digestive and respiratory management. He remained on a ventilator and sustained significant, permanent, brain damage. He was placed in a care facility due to his extensive care needs.

In 2002, the FDA advised that powdered infant formulas are not commercially sterile products. Powdered milk-based infant formulas are heat-treated during processing, but unlike liquid formula products they are not subjected to high temperatures for sufficient time to make the final packaged product commercially sterile. Although liquid sterile formulas are available for premature, or low birth weight infants, increasingly these infants are given powdered formulas as they are readied for transition to their homes. In light of the epidemiological findings and the fact that powdered infant formulas are not commercially sterile products, FDA recommended that powdered infant formulas not be used in neonatal intensive care settings unless there was no alternative available.