We thank the authors for the interest in our article. Some of the
methodological details and results of the study were not included in the
manuscript due to the word limit. We regret the errors in the abstract
of this article, and thank the readers for pointing them out.
We agree with the comment regarding possibility of
low vitamin D level in children with chronic disease/ drug intake for
chronic conditions. Many of the children admitted to our intensive care
unit had an underlying chronic illness. These conditions were: chronic
liver disease (16), congenital heart disease (14) , metabolic disorder
(9), congenital malformation (6), type-1 diabetes mellitus (6), asthma
(4), tuberculosis (6), HIV (4), rheumatological diseases (6), cystic
fibrosis (4), primary immunodeficiency (2) and others (9).
Many of the illnesses in childhood are associated
with low Vitamin D levels. If we had excluded the children admitted with
underlying/ chronic illnesses like liver disease and neurological
disease, we would have been left with small subset of population in our
sample. As children with central nervous system infections and liver
disease contribute significantly to intensive care hospitalizations in
tropical countries, we did not exclude these conditions in order to get
a true picture of vitamin D status in intensive care settings.
Most of the children who were vitamin D-deficient
were also deficient in calcium. One of the objectives of the study was
to characterize vitamin D deficiency status in relation to parathyroid
response; therefore we presented data of, only those children who were
vitamin D- deficient. We agree with your comment regarding importance of
iCa levels in critical illness. It was not feasible to measure iCa in
all the patients in our study. Blood samples for laboratory
investigations (Calcium, PTH, Vitamin D, etc) were collected at the
baseline at the time of admission. Therefore, calcium supplementation in
hypocalcemic patients after PICU admission would not alter the
laboratory values of calcium, PTH or vitamin D. Children with
hypocalcemia were managed based on the unit protocol, supported by the
clinical profile.
Regarding feeding status, most of the children
consumed animal milk [local dairy company (28.6%); direct milk from
animal sources (24.7%)]. Seven percent of the children were on
commercially available formula feeds, 11.7% were on breast feed and 28%
of children were on both formula and breast feeds. Those fed on both
breast feed and formula were less likely to be vitamin D deficient
compared to other types of milk supplementation.
Reference