How should respiratory distress due to bilateral choanal atresia be managed?

In the case of respiratory distress due to bilateral choanal atresia, managing the airway is crucial because this condition can impede the flow of air through the nasal passages. The best management strategy is to insert a modified feeding nipple or pacifier into the mouth. This method creates an oral airway, allowing the newborn to breathe and thereby relieving immediate respiratory distress, as infants primarily breathe through their noses.

By providing an oral airway, you can circumvent the obstruction caused by the choanal atresia until further interventions can be considered. This approach stabilizes the infant's condition and allows for easier passage of air, which is critical when there is an acute respiratory crisis.

In contrast, other methods such as intubation through the nose may be inappropriate because the condition specifically obstructs nasal air passage, making nasal intubation challenging and possibly harmful. Suctioning the airway might not address the fundamental problem of obstruction caused by the atresia, and immediate surgery, while ultimately necessary for a permanent fix, is not always the immediate solution when the newborn is in acute distress. Consequently, using a modified feeding nipple or pacifier serves as an effective temporizing measure.