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ABSTRACT:  Early in this century, outbreaks of Enterobacter sakazakii among infants fed on powdered infant formula in Western Europe and the United States forced a rethinking of the cherished belief that artificial feeding is a very safe choice for infants in the developed world. Alarmed by these reports, the World Health Organization and the Food and Agriculture Organization convened an Expert Meeting in 2004 to determine the causes and again in 2006 to develop guidelines for reducing the risk to infants from intrinsic bacterial contamination in powdered infant formula. Reducing the frequency of contamination at the manufacturing level would eliminate about 80 percent of the problem. Reconstituting the formula with water boiled and cooled to no less than 70° C is critical to destroy remaining bacteria. Arguments from the infant formula industry, some segments of the medical community, and some Western countries against this “lethal step” trivialize the scope and severity of the problem and ignore clear scientific evidence. (BIRTH 37:1 March 2010)