Tracheal squamous metaplasia in children with endotracheal intubation or tracheostomy.

ABSTRACT 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 μm 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.