87 Squamous Metaplasia and Necrosis of Trachea and Larynx after Nasotracheal Intubation of Premature Infants

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.

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Squamous metaplasia and necrosis of thetrachea complicating prolonged nasotracheal intubation of small newborn infants

The Journal of Pediatrics ◽

10.1016/s0022-3476(67)80104-5 ◽

1967 ◽

Vol 71 (4) ◽

pp. 534-541 ◽

Cited By ~ 24

Author(s):

Paul S. Symchych ◽

Marcel Cadotte

Keyword(s):

Squamous Metaplasia ◽

Nasotracheal Intubation ◽

Newborn Infants

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Otitis Media in the Neonatal Intensive Care Unit

PEDIATRICS ◽

10.1542/peds.62.2.198 ◽

1978 ◽

Vol 62 (2) ◽

pp. 198-201

Author(s):

Steven A. Berman ◽

Thomas J. Balkany ◽

Michael A. Simmons

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Tympanic Membrane ◽

Otitis Media ◽

Premature Infants ◽

Neonatal Intensive Care ◽

Nasotracheal Intubation ◽

Gram Negative ◽

Otoscopic Examination

Thirty-eight of 125 premature infants who were hospitalized in a neonatal intensive care unit (NICU) had abnormal tympanic membrane mobility compatible with otitis media. Twenty-five of these 38 had received antibiotics within one week of otoscopic examination and were considered to have either serous otitis or partially treated bacterial otitis media; tyinpanocentesis was not performed in them. Tympanocentesis was performed in the remaining 13 infants who had not received antibiotics. Bacterial otitis media was confirmed in ten of the 13. Either staphylococcal (six cases) or Gram-negative enteric organisms (four cases) were isolated in cultures obtained by tympanocentesis in these cases. The four cases of Gramnegative infections occurred in infants within six weeks of birth. Nasotracheal intubation for more than seven days was significantly correlated with impaired tympanic membrane mobility compatible with otitis media. Otitis media occurs frequently among premature infants who are hospitalized in an NICU, and it should be looked for in any infant in whom sepsis is clinically suspected.

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Ten-Year Review of Pediatric Tracheotomy

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948309200422 ◽

1983 ◽

Vol 92 (4) ◽

pp. 398-400 ◽

Cited By ~ 81

Author(s):

Peter Carter ◽

Bruce Benjamin

Keyword(s):

Airway Obstruction ◽

Premature Infants ◽

Granulation Tissue ◽

Reconstructive Surgery ◽

Nasotracheal Intubation ◽

Craniofacial Abnormalities ◽

Pediatric Hospital ◽

Acute Epiglottitis ◽

Minimal Morbidity

One hundred sixty-four consecutive tracheotomies are reviewed over the 10-year period 1972–1981. Early in the series acute inflammatory airway obstruction was the major indication for tracheotomy, being 60% of cases in the first 3 years. In the last 3 years this fell to approximately 15%. After 1975 nasotracheal intubation replaced tracheotomy for acute epiglottitis. More recently it has become the treatment of choice for acute laryngotracheobronchitis. Tracheotomy prior to reconstructive surgery for major craniofacial abnormalities is becoming more frequent. Acquired subglottic stenosis is not a problem in our hospital despite the use of long-term nasotracheal intubation in premature infants, and no tracheotomies were performed for this indication. There were few major complications. Decannulation difficulties were due to obstruction by stomal granulation tissue or displaced flap of anterior tracheal wall. There was no case of hemorrhage, no posttracheotomy stenosis, and no death was attributable to tracheotomy. These results demonstrate that in a major pediatric hospital tracheotomy is a relatively safe and effective procedure with minimal morbidity.

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