Picture this you and your significant other had just given birth to

Picture this, you and your significant other had just given birth to a beautiful baby. The nurse takes your baby away to clean them up. The nurse looks concerned and the doctor comes rushing in. You are now informed that your babies stats are dropping and from where you are you can see that your baby is looking more of a bluish color. The doctor informs you that they are going to have to intubate your newborn child so they can figure out what is wrong and to help keep the stats up. After waiting for a long time while recovery from giving birth the doctor comes to let you know your baby has a rare but fixable disorder called Choanal Atresia. Choanal Atresia is a congenital disorder where the nasal passage gets blocked off by a bone or soft tissue, which makes airflow difficult or impossible. This can occur because of failed recanalization of the nasal fossae during fetal development (Andaloro, C.). There are two different types of Choanal Atresia, Unilateral and Bilateral. If a baby is born with Unilateral Choanal Atresia then surgery is not needed, because the baby can survive with breathing through only one nasal passage. On the other hand, if a baby is born with Bilateral Choanal Atresia then a surgical procedure will need to take place. Survival is still considerably high, after surgery is taken place, and the baby can still live a healthy life. According to our Neonatal and Pediatric textbook “Choanal atresia occurs in approximately 1 in 700 live births, with females affected 2:1 over males. Unilateral choanal atresia is twice as common as bilateral choanal atresia” (Walsh, B. K.). Choanal atresia is part of a cluster of defects with the acronym “CHARGE” which stands for “colobomas, heart defects, choanal atresia, retarded development, genital hyperplasia, and ear anomalies.” Choanal atresia is often associated with isolated congenital heart defects. According to Claudio Andaloro, “Nasal choanae develop between the third and seventh embryonic weeks, following the rupture of the vertical epithelial fold between the olfactory groove and the roof of the primary oral cavity (stomodeum). The following theories have been proposed to explain the pathogenesis of choanal atresia: the persistence of the buccopharyngeal membrane, the persistence of the nasobuccal membrane of Hochstetter, the incomplete resorption of the nasopharyngeal mesoderm, and the local misdirection of neural crest cell migration. These theories are associated with molecular and genetic studies to give further insights into the pathogenesis of choanal atresia” (Andaloro, C.). The exact reason for this disorder isn’t actually known but there are theories that are pretty accurate. Healthline states that there are reports “Women who took certain thyroid drugs, such as carbimazole and methimazole (Tapazole), during pregnancy gave birth to babies with choanal atresia at a higher rate” (www.healthline.com). The association isn’t completely clear, because of these cases it is not proven that the disorder was caused by the medication itself or if the thyroid diseases of the mothers were the cause. Luckily unlike other diseases or disorders that aren’t very clear of the causes, this one is easily treated and the patients that get the surgical procedures can continue to live a normal and healthy lifestyle afterwards. That is if surgery is medically necessary, depending on the severity of the disorder (unilateral or bilateral). According to Medscape, the first known case of Choanal atresia was in 1755 which means this disorder has been known for over 200 years. The first successful surgical procedure was a hundred years after the first case was found. In 1854 surgery was done to a 7-year-old boy using a curved trocar trans nasally (emedicine.medscape.com). Referring to this it must have been a unilateral case, because of the inability to survive with bilateral without surgery. As I said previously there are two levels of choanal atresia, unilateral and bilateral. With unilateral choanal atresia symptoms aren’t very common at first. After birth a baby may or may not show any symptoms. Someone with unilateral may not show signs of having for years, and even with someone showing symptoms years after being born, there may not have to be anything done for it, because someone can survive using only one nasal passage. Bilateral on the other hand will most likely have symptoms right after birth if not as the doctor is delivering the baby. Some of the signs and symptoms people should look out for for bilateral choanal atresia are; Chest retracts unless the child is breathing through mouth or crying. Difficulty breathing following birth, which may result in cyanosis (bluish discoloration), unless infant is crying. Inability to nurse and breathe at same time. Inability to pass a catheter through each side of the nose into the throat. Persistent one-sided nasal blockage or discharge (medlineplus.gov). Most babies breathe through their nasal passage more than the oral airway. For this reasoning the signs and symptoms can occur pretty fast. If the baby is a nose breather, then they will become cyanosis when trying to breathe through their nose. If the baby is crying which a lot of babies do after birth, they will be able to get oxygen from the oral airway and won’t turn that bluish color. If the baby doesn’t show signs due to crying after birth, then when the baby is trying to nurse it won’t be able to feed and breathe at the same time. In this case the baby will then become cyanotic and stats will begin to drop. Another sign can be if the doctor or nurse try to pass a nasal catheter through the nasal airway but are not able to complete this task. This would be due to the blockage by the extra bone or soft tissue. Any of these signs or symptoms will be indications for a doctor to assume the baby has bilateral choanal atresia. Which then the baby will need to be intubated to bypass the upper

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