Tracheal squamous metaplasia in children with endotracheal intubation or tracheostomy

Objectives: In the present study, tracheal epithelial biopsy samples between intubated children, children with tracheostomy and a control group of non-intubated children are compared with respect to their degree of normal differentiation versus the presence of squamous metaplasia. Methods: Tracheal epithelial biopsies were obtained from intubated neonates undergoing tracheostomy, children with tracheostomy undergoing suprastomal granuloma excision and non-intubated control children undergoing laryngoscopy and bronchoscopy. Paraffin tissue blocks were sectioned at 5 mu m thickness and subjected to both routine Hematoxylin and Eosin (H&E) staining and immunostained with the relevant antibodies for markers of epithelial differentiation including B-tubulin, CC10, Muc5ac, P63, keratin5 and keratin14. Results: Squamous metaplasia was seen in 3/3 infants, all intubated and in 3/3 children with tracheostomy tubes in place undergoing excision of suprastomal granuloma. No metaplasia was observed in control tracheal epithelial biopsies in 7/7 non-intubated children. Conclusion: Our results demonstrate a clear association between intubation or tracheostomy and the presence of squamous metaplasia which is not otherwise encountered in control pediatric tracheal biopsies.