Surgical Causes of Neonatal Respiratory Distress

Airway Obstructive Lesions

Bilateral choanal atresia occurs in 1 in 7,000-8,000 live births with female predominance (2:1) and presents as 40% bilateral, 60% unilateral cases 1
Newborns are obligate nasal breathers during the first 3-4 weeks of life, making bilateral atresia life-threatening immediately after birth 1, 2
These infants present with periodic respiratory distress and cyanosis that is relieved by crying, along with severe feeding problems and aspiration 1, 2
Immediate airway management requires oropharyngeal airway intubation within the first hours of life before planning surgical correction within the first days of life 1, 2
Diagnosis is established by inability to pass a catheter through either nostril into the pharynx, confirmed by endoscopic examination and high-resolution CT scan 1, 2
The atretic plate is either purely bony (30%) or mixed bony/membranous (70%), with 50% having associated congenital abnormalities (up to 75% in bilateral cases) 1, 2
CHARGE malformation is the most frequent syndromal association (20% of cases), requiring two of the following: Coloboma, Heart defects, Choanal Atresia, Retardation, Genito-urinary abnormalities, and Ear defects 1

Do not administer surfactant to infants with congenital diaphragmatic hernia, as this increases mortality, ECMO requirements, and chronic lung disease 3, 4
Do not delay surgical intervention in bilateral choanal atresia—these infants require immediate airway management within hours of birth 1, 2