Snapshot A newborn is noted to be cyanotic while in the well-baby nursery during feeds. When the feed is withdrawn, the newborn begins to cry and turns pink. A 6 French suction catheter fails to pass through the nose. Introduction Overview posterior nasal airway congenital occlusion Associated conditions can be associated with CHARGE syndrome (Coloboma, Heart defects, Atresia choanase, Retarded growth and development, Genital hypoplasia, and Ear anomalies and deafness) Epidemiology incidence 1 in 5,000-8,000 live births demographics more common in females location unilateral occlusion is more common than bilateral occlusion risk factors a possible risk factor is thionamide (e.g., methimazole) use during pregnancy ETIOLOGY Pathophysiology pathoantomy currently unclear Presentation Symptoms bilateral choanal atresia respiratory distress neonates are nasal breathers for the first 6 weeks of life paradoxical cyanosis cyanotic infant turns pink when crying unilateral choanal atresia foul-smelling secretion from the affected nares may have a unilateral otitis media; however, this is less common Physical exam inability to pass a French catheter into the nasopharynx if associated with CHARGE syndrome, one may find ear anomalies coloboma abnormalities in the genitalia heart defects Imaging Computed tomography (CT) scan indications the test of choice to confirm the diagnosis of choanal atresia views paranasal sinuses and skull base findings includes posterior nasal cavity narrowing and lateral wall thickening of the nasal cavity Studies Diagnostic criteria clinical findings and CT scan of the paranasal sinuses and skull base Differential Bilateral nasolacrimal duct cysts Septal deviation Nasal tumor Treatment Operative intranasal repair indications definitive treatment for choanal atresia must be done as soon as possible for bilateral choanal atresia perform as soon as possible for neonates with bilateral atresia outcome recurrent stenosis may occur Prognosis Prognostic variable negative bilateral choanal atresia can be life-threatening if not quickly treated Complications Aspiration Respiratory arrest Post-surgery renarrowing