Preoperative airway management in a preterm with bilateral choanal atresia

Abstract

Bilateral choanal atresia (CA) is a recognized neonatal emergency. Before corrective surgery, provision of a secure airway is crucial. No approach has been specifically advocated for preterm infants. We describe successful use of a novel airway in a preterm infant with CA.

Treatment of bilateral choanal atresia in the premature infant

“…A tracheotomy, while providing for a secure airway, brings its load of negative impacts, including increased airway complications, increased health care costs with prolonged hospital stay and the necessity of home nursing and tracheotomy care, as well as increased social and parental burden. All but one of the premature infants with bilateral choanal atresia described in the literature were kept intubated or on an oral airway for a few weeks to let them grow before definitive treatment using a standard transnasal repair was undertaken, prolonging their stay in the intensive care unit [4][5][6][7]. However, the 34-week premature infant treated with Holmium:YAG laser could be treated within a few days of life using this technique, leading to early discharge home [3].…”

“…The literature describes only a few cases of bilateral choanal atresia in the premature infant population [3][4][5][6][7]. This unusual event brings unique Summary An innovative technique for choanal atresia repair was used for a unique case of bilateral choanal atresia in a 28-week premature newborn.…”

“…Bilateral choanal atresia is a rare and challenging disease occurring in 1 every 10,000 births [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. The anatomic classification of choanal atresia was classically described as 90% bony and 10% membranous; however, more recent studies using high-resolution CT scan revealed that 30% of the atresia were purely bony and 70% were a mixed bony-membranous anomaly [2][3][4][5][6][7][8][11][12][13][14][15].…”

“…The anatomic classification of choanal atresia was classically described as 90% bony and 10% membranous; however, more recent studies using high-resolution CT scan revealed that 30% of the atresia were purely bony and 70% were a mixed bony-membranous anomaly [2][3][4][5][6][7][8][11][12][13][14][15]. Theories proposed to explain this congenital malformation include failure of the bucconasal membrane to rupture, persistence of the buccopharyngeal membranes, medial outgrowth of vertical and horizontal processes of the palatine bone and possible defects in neural crest migration [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”

“…The diagnosis should also be raised when failed extubation of a newborn occurs. Associated congenital anomalies occur in 20-50% of patients [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”