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choanal atresia of newborn :
Choanal atresia is caused by a failure of
embryologic regression of nasal airway tissue, thereby resulting in a partial or
complete occlusion of the nasal airway. These choanal defects may be bony or
membranous, with most having a boney component. Complete bilateral stenosis
usually results in a neonatal respiratory emergency at birth because infants
generally are obligate nasal breathers during the first 6-8 weeks of life. At
rest, these infants usually manifest severe apnea, retractions, and respiratory
distress that may be relieved with crying.
Wheezing or stridor may be
audible with inspiration, and collapse of the small airways with vigorous
inspiratory effort can occur. The infant in respiratory distress should be
stimulated to cry and an artificial oral airway may be used to avoid
intubation.
The clinical diagnosis is achieved by the inability to pass a
small caliber catheter through the nasal passages. However, the act of passing
catheters, especially with repeated attempts, causes nasal passage swelling in
any infant with the subsequent iatrogenic occlusion mimicking the congenital
condition.
An alternative noninvasive method of excluding the diagnosis
of complete atresia is to place a glass slide under the nasal orifices and look
for fogging with expiration. Supplemental oxygen should be administered to
infants with choanal atresia, and an oral airway may be of assistance.
If
the infant remains in significant respiratory distress, intubation is necessary.
Intubation relieves the obstruction so that minimal ventilation (if any) is
required.
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