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Shareef Fatima, born prematurely at 33 weeks with very low birth weight (1.10 kg), had respiratory distress immediately after birth. She was brought to CARE Hospitals, Banjara Hills, Hyderabad on ventilator support and required a life-saving endoscopic nasal surgery. The doctors in the ENT Department tried passing a suction catheter tube into the nose to check for nasal patency, which showed obstruction on both the sides. The baby was diagnosed with bilateral congenital choanal atresia, which is life-threatening, unless an oral airway is kept in the mouth immediately after birth or the baby is intubated and ventilated. The diagnosis was confirmed by a CT scan of the paranasal sinuses.
Bilateral choanal atresia is a rare congenital condition (1 in 7000 live births), in which there is complete obstruction of the posterior nasal openings on one or both the sides. It causes an acute respiratory emergency at birth.
Baby Fatima was taken for emergency endoscopic surgery under general anesthesia. She was weaned off the ventilator on the second postoperative day and a stent was placed to facilitate nasal breathing. The stents were kept in the nose for about 4 to 6 weeks to maintain the patency of nasal breathing.
This life saving endoscopic nose surgery on a 33-week, pre-term and premature baby is very rarely reported in world literature. This was the first such surgery using endoscopic surgical repair and 1 mm Skeeter drill. Special equipment like small diameter endoscopes, brought from Delhi (KARLSTORZ, Germany) and Skeeter drill (Medtronics, USA) were used to reconstruct the nasal passages and relieve nasal obstruction. Baby Fatima was a special baby as earlier two children of the parents had died. If the life-threatening condition of bilateral congenital choanal atresia is diagnosed immediately after birth, the baby can be saved by inserting a simple oral airway, which can be done in smaller hospitals or even for babies delivered by a midwife in a village. An initial life-saving simple measure of putting an oral airway into the mouth, immediately after birth, can be done by a healthcare professional, until the baby is shifted to a tertiary centre with facilities for ventilation and further endoscopic surgical repair.