Question
A newborn develops respiratory distress and cyanosis shortly after birth. The cyanosis improves when the baby cries. On examination, a feeding catheter cannot be passed through either nostril, and there is no misting on a cold laryngeal mirror placed beneath the nostrils.
What is the most appropriate immediate management?
| A. |
Endotracheal intubation
|
| B. |
Oropharyngeal airway insertion
|
| C. |
Oxygen inhalation alone
|
| D. |
Epinephrine nebulization
|
Show Answer
|
Correct Answer » B
Explanation
|
|
The clinical picture is suggestive of bilateral choanal atresia.
Key Clinical Clues
- Cyanosis that improves on crying
- Newborns are obligate nasal breathers.
- Crying opens the mouth, allowing oral breathing and relieving cyanosis.
- This is the classic hallmark of bilateral choanal atresia.
- Failure to pass a catheter through the nostrils
- Suggests obstruction of the posterior nasal choanae.
- Absence of misting on the laryngeal mirror test
- Indicates absent nasal airflow.
Diagnosis
Bilateral Choanal Atresia
- Congenital obstruction of the posterior nasal apertures (choanae).
- Caused by persistence of the bucconasal/buccopharyngeal membrane.
- May be bony, membranous, or mixed.
Immediate Management
The priority is to establish an airway.
Measures include:
- Keeping the mouth open
- Oral digital manipulation of the tongue
- Placement of an oropharyngeal airway
- McGovern nipple (open-tip nipple)
Thus, the most appropriate immediate management is:
Oropharyngeal airway insertion
Why Other Options Are Incorrect
A. Endotracheal Intubation
- Not the first-line management.
- Reserved for severe respiratory distress or failure of simpler airway measures.
C. Oxygen Inhalation Alone
- Oxygen does not bypass the mechanical nasal obstruction.
- Airway patency must be established first.
D. Epinephrine Nebulization
- Used for upper airway edema (e.g., croup).
- Has no role in congenital choanal obstruction.
