Hydrolysed Formula Is a Risk Factor for Vitamin K Deficiency in Infants With Unrecognised Cholestasis

Peter M. van Hasselt*, W. de Vries, E. de Vries, K. Kok, E. C. M. Cranenburg, T.J. de Koning, L. J. Schurgers, Henkjan J. Verkade, Roderick H. J. Houwen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives: Vitamin K deficiency (VKD) may cause life-threatening haemorrhages, especially in breast-fed infants with unrecognised cholestasis. Interestingly, hypoallergenic formulas appear overrepresented in reported cases of VKD bleeding (VKDB) in formula-fed infants. We therefore assessed whether the risk of VKD in formula-fed infants with cholestasis is associated with hypoallergenic formulas. Patients and Methods: Infants born in the Netherlands between January 1991 and December 2006 with cholestatic jaundice due to biliary atresia (BA) or to alpha-1-antitrypsin deficiency (A1ATD) were identified in the Netherlands Study Group for Biliary Atresia Registry and the A1ATD registry, respectively. The relative risk (RR) of VKDB in patients with BA or A1ATD was calculated for different formula types. The influence of prior or ongoing breast-feeding on the RR of VKDB was also assessed. Results: A total of 179 infants with either BA (139) or A1ATD (40) were included. One hundred eighteen infants were formula fed; 8 presented with VKD. Six of these 8 infants (75%) received hypoallergenic formula (whey-based hydrolysate in 4). One infant on whey-based hydrolysed formula presented with VKDB. Risk factor analysis revealed that infants receiving hydrolysed, especially whey-based, formula, had a strongly increased risk of VKD (RR 25.0 [6.4-97.2], P
Original languageEnglish
Pages (from-to)773-776
JournalJournal of Pediatric Gastroenterology and Nutrition
Issue number6
Publication statusPublished - Dec 2010


  • haemorrhagic disease
  • hydrolysate
  • liver disease
  • prophylaxis
  • surveillance and monitoring
  • vitamin K deficiency

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