Libro blanco de las ACES Pediátricas 2024

Libro Blanco de las ACES Pediátricas 2024 596 ❚ Pulmonology 1. Clinical Diseases A. Disorders of the upper airways 1. Congenital abnormalities a. Choanal atresia/stenosis 1. Epidemiology a. Know the association between choanal atresia and other congenital defects 2. Etiology/Genetics 3. Pathophysiology a. Pathology b. Path mechanisms and consequences 4. Diagnosis and clinical manifestations a. History 1. Recognize choanal atresia as a cause of cardiorespiratory failure on the first day after birth 2. Recognize choanal atresia as a cause of apnea, cyanosis, and respiratory distress relieved with crying in a neonate b. Physical examination 1. In assessing choanal patency, recognize the importance of assessing nasal airflow while the patient's mouth is closed 2. Recognize that choanal atresia or stenosis may be unilateral or bilateral c. Imaging 1. Recognize the radiographic appearance of choanal atresia on radiopaque dye studies or CT scans d. Other investigations 1. Recognize that the simplest way to establish the diagnosis of choanal atresia in infants is by attempting to pass a small catheter through each nostril 2. Recognize that the finding that only a catheter smaller than a #8 French can be passed through the nasal passage of an infant is consistent with the diagnosis of choanal stenosis e. Diagnostic criteria - NA f. Complications 1. Recognize that infants with choanal atresia are at risk for cyanosis and aspiration during feeding 5. Therapeutic approach a. Recognize that endotracheal intubation is the most effective initial treatment of choanal atresia in a symptomatic infant b. Recognize that the definitive treatment of both membranous and bony choanal obstruction is surgical excision with prolonged placement of a Silastic tube (for weeks) to prevent recurrence 6. Prognosis a. Natural history 1. Recognize that untreated choanal atresia may result in life- threatening apnea, cyanosis, and death