Assuring microbiological food safety of preterm nutrition is a specific challenge. Especially the very low birth weight and the not fully developed immune system makes preterm infants even more susceptible to infections than the new born infant in general. This is also due to the fact that breast feeding is often not possible for these infants. There are different obstacles for breast-feeding as intensive care conditions and individual nutrition requirements of the newborn. There are microbiological aspects of preterm nutrition including quality requirements of commercial formula, breast milk fortifiers and extracted breast milk which deviate dramatically from hygiene requirements of hospital food. The main pathogens of concern are Cronobacter spp., Salmonella spp., and Clostridium botulinum, which require different precautionary measures. The hygiene aspects of preparation techniques for preterm formula, the storage conditions and the microbiological risks linked to certain feeding techniques (e.g. tube feeding) are key aspects of the preparation. The risks associated with microorganisms found in commercial formula and in the preparation environment, as well as the risk of biofilm formation, will be discussed. There are options and requirements for risk mitigation.The application of the Hazard Analysis and Critical Control Points concept (HACCP) can be a useful tool for the control of risks in the preparation of formula. HACCP is a widely used concept in the food industry. The concept provides a structured way to identify, analyse and assess potential hazards followed by a systematic implementation of precautionary and control measures. The concept is completed by a clear set of verification procedures. The application of the concept in small nonindustrial environments like a milk preparation room is challenging. Nevertheless, the systematic approach is a clear advantage for the efficient implementation of risk mitigation measures.

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