Response to Comment on Jaworska, J. et al. Consensus on the Application of Lung Ultrasound in Pneumonia and Bronchiolitis in Children. Diagnostics 2020, 10, 935.

Thank you for the opportunity to respond to the issues raised by Nenna et al [...].

Consensus on the Application of Lung Ultrasound in Pneumonia and Bronchiolitis in Children.

This evidence-based consensus aims to establish the role of point-of-care lung ultrasound in the management of pneumonia and bronchiolitis in paediatric patients. A panel of thirteen experts form five Polish tertiary pediatric centres was involved in the development of this document. The literature search was done in PubMed database. Statements were established based on a review of full-text articles published in English up to December 2019. The development of this consensus was conducted according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluations)-adopted and Delphi method. Initially, 22 proposed statements were debated over 3 rounds of on-line discussion and anonymous voting sessions. A total of 17 statements were agreed upon, including four statements referring to general issues, nine referring to pneumonia and four to bronchiolitis. For five statements experts did not achieve an agreement. The evidence supporting each statement was evaluated to assess the strength of each statement. Overall, eight statements were rated strong, five statements moderate, and four statements weak. For each statement, experts provided their comments based on the literature review and their own experience. This consensus is the first to establish the role of lung ultrasound in the diagnosis and management of pneumonia and bronchiolitis in children as an evidence-based method of imaging.

Bacterial meningitis in neonates and infants - the sonographic picture.

Bacterial meningitis is a major diagnostic and therapeutic problem among children and neonates, with severe, rapidly progressing course and potentially life-threatening complications. Early antibacterial treatment is essential for the patient's favorable prognosis. Cerebral imaging plays an important role in the diagnostic process alongside physical examination and laboratory tests. Magnetic resonance imaging is the gold standard for diagnosing bacterial meningitis. Because of limited availability of magnetic resonance imaging, cranial ultrasound is the first imaging procedure to be performed (if the anterior fontanelle is preserved providing an adequate acoustic window). The safety and reliability of ultrasound examination, possibility to perform the examination at bedside without the need for sedation make cranial ultrasound a useful tool both for preliminary diagnostic investigation and for the monitoring of both treatment and long-term complications. Sonographic findings in patients with bacterial meningitis and possible complications are diverse. Changes can be seen on the surface of the brain, in the extra-axial space, in the ventricular system and in brain tissue. In some cases they can also be visible in the lumbosacral segment of the spinal cord. This paper presents ultrasound characteristics of lesions associated with bacterial meningitis in neonates and infants, based on the authors' own material and data from the available literature.