A neonate presents with respiratory distress and cyanosis that worsens during feeding but improves with crying. This presentation is characteristic of choanal atresia. The immediate management is:

• A Immediate endotracheal intubation and mechanical ventilation in all cases
• B Emergency tracheotomy as first-line treatment for all cases of choanal atresia
• C Insert oral airway (McGovern nipple) to maintain airway; surgical correction (endoscopic transnasal choanoplasty) deferred until stability, typically within first weeks of life for bilateral bony atresia ✓
• D Nasopharyngeal airway insertion; surgical repair is elective at 5-6 years of age

Explanation

Bilateral choanal atresia is a neonatal emergency because neonates are obligate nasal breathers. The cyanosis-during-feeding/improvement-with-crying pattern (oxygen paradox) is pathognomonic. Immediate airway management with an oral airway (McGovern nipple) allows breathing. Definitive treatment is endoscopic transnasal choanoplasty under general anesthesia — performed within days to weeks in bilateral bony atresia. Unilateral choanal atresia is less urgent and diagnosed later. Associated CHARGE syndrome (Coloboma, Heart defects, Atresia choanae, Growth retardation, Genital anomalies, Ear anomalies) must be excluded.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.