Growth faltering in a preterm infant associated with inaccurate formula preparation by an automated formula dispenser.

Inadequate caloric intake is a common cause of faltered growth in infants. When investigating an infant with faltered growth, it is important to ensure recommended feeding volumes. Both overdiluted and underdiluted milk formula are common when mixing milk formula. In recent years, automated formula dispensers have been available to facilitate the preparation of milk formula. Our case illustrates a preterm infant who presented with faltered growth in combination with brief apnoea and hypothermia. After clinical examination, investigation and history taking, it was concluded that the faltered growth was a result of underdiluted milk formula produced by an automated formula dispenser. Our case report aims to raise awareness regarding the potential risk of faltered growth when using an automated milk formula dispenser. Hence, encouraging healthcare professionals to improve the history taking when investigating an infant with faltered growth, as well as informing caregivers that using a milk formula dispenser is not infallible.