A newborn with bilateral choanal atresia presents with cyclic cyanosis that improves with crying. The immediate management is:

• A Nasal CPAP
• B Immediate tracheotomy
• C Oropharyngeal (Guedel) airway insertion to bypass the obstruction until surgical correction ✓
• D Nasal decongestion with xylometazoline

Explanation

Bilateral choanal atresia is a neonatal emergency because neonates are obligate nasal breathers. Cyclic cyanosis worsening at rest (when the mouth is closed) and improving with crying is the hallmark. An oropharyngeal (Guedel) airway is inserted immediately to establish an oral airway, which is life-saving. Definitive repair (transnasal endoscopic choanoplasty) is performed once the neonate is stabilised. Tracheotomy is reserved for cases where the oral airway fails or associated severe airway pathology exists.

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.