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Mucosal changes in the trachea and main bronchi of newborn infants after naso-tracheal intubation
Insights
Nasotracheal intubation in infants can cause tracheal and bronchial mucosal damage. Squamous metaplasia often replaces lost tissue, with suction catheters potentially causing more injury than the tube itself.
Area of Science:
- Pediatric Pulmonology
- Histopathology
- Neonatal Care
Background:
- Nasotracheal intubation is a common neonatal procedure.
- While permanent sequelae are rare, acute airway injury can occur.
Purpose of the Study:
- To investigate the histological changes in the trachea and main bronchi of infants following nasotracheal intubation.
- To compare the extent of mucosal damage and metaplasia in intubated versus non-intubated infants.
Main Methods:
- Histological examination of tracheal and bronchial sections from 12 infants intubated for over a week.
- Comparison with sections from non-intubated infants or those intubated for shorter durations.
- Classification of lesions based on mucosal loss and squamous metaplasia.
Main Results:
- Squamous metaplasia was observed in most intubated infants, indicating tissue repair.
- Airway lesions were more pronounced in the right main bronchus and lower trachea.
- Infants intubated for shorter periods showed mucosal loss and early metaplasia.
- Suction catheter trauma may exceed endotracheal tube-induced injury.
Conclusions:
- Nasotracheal intubation can lead to acute mucosal injury and squamous metaplasia in infants.
- The distribution of lesions suggests specific sites of vulnerability within the airway.
- Further research into minimizing iatrogenic airway trauma during intubation and suctioning is warranted.
Abstract:
Permanent sequelae of nasotracheal intubation are uncommon, but acute ulceration and squamous metaplasia occur. Histological sections from the trachea and main bronchi were examined in 12 infants. A nasotracheal tube had been inserted during the first two weeks of life of these infants and had been in place for more than one week. In four cases the patient died some time (7 to 108 days) after extubation. Similar sections from patients who were not intubated, intubated only for attempted resuscitation, or intubated for several hours were studied for comparison. The sections were classified according to the degree of mucosal loss and metaplasia, and the extent of the lesions was estimated. Squamous change was seen in most sections from all 12 patients with the exception of one who died 57 days after extubation. Some respiratory epithelium was seen in all patients. In the eight patients who died while intubated, the changes were more marked in the right main bronchus than the left in seven, and more marked in the lower trachea than the upper in five. In the two patients intubated for several hours, in addition to mucosal loss, early metaplasia was seen. It is suggested that mucosal loss is replaced by the squamous metaplasia, and that trauma caused by suction catheters in the lower trachea and right main bronchus is more extensive than that due to the endotracheal tube itself.