Most newborn infants breathe through the nose and open the mouth only to cry or feed. The inhibition against mouth-breathing is sometimes so strong that obstructing the nose leads to suffocation. This is believed to account for some asphyxial deaths in newborn infants, since bilateral choanal atresia may exist. Even unilateral choanal atresia can be fatal if the remaining normal passage is temporarily obstructed. The diagnosis is made by measuring the depth to which a metal probe can be passed into the nose. A depth of less than 32 mm. (1 1/4 in.) means atresia; a depth of more than 44 mm. (1 3/4 in.) means patency. Data on the causes of neonatal asphyxial death will not be reliable until pediatricians include the choanal patency test in their regular procedure for the physical examination of infants, but it is believed that a perceptible reduction of the mortality from neonatal asphyxia can be achieved by keeping in mind the possibility of choanal atresia.
Beinfield HH. WAYS AND MEANS TO REDUCE INFANT MORTALITY DUE TO SUFFOCATION: IMPORTANCE OF CHOANAL ATRESIA. JAMA. 1959;170(6):647–650. doi:10.1001/jama.1959.03010060015004
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