PEDIATRICS Vol. 107 No. 1
January 2001,
pp. 214-214
A Nontraumatic and Inexpensive Clinical Maneuver to Check Nasal
Patency at Birth
To the Editor.
Neonates are preferential nasal breathers, and nasal obstruction
at birth can cause central cyclic cyanosis and represents a potentially
life-threatening condition.1 Causes of neonatal nasal
obstruction include choanal atresia, nasal septum deviation, hematoma,
enkephalocele, etc. Checking choanal patency is then a mandatory
routine in the delivery room introducing through each nostril a 6-Fr,
side-opened catheter.2 However, the catheter may harm the
nasal mucosa, and it is a medical cost to be added to the 10-Fr
catheter recommended for suctioning secretions through the
mouth.3
At the delivery room unit of our Neonatology Division where we attend
>3000 deliveries per year, we perform a simple clinical maneuver to
check choanal patency. With her/his left little finger, the examiner
gently keeps the newborn's mouth closed while the thumb obstructs
without compressing the left nostril. The stethoscope's membrane is
held by the right hand just under the right nostril. The gentle sound
of air flowing out of the tested nare then becomes clearly audible.
This maneuver is then repeated on the opposite side. We anecdotally
report that in the last 2 years the "nasal air-flow test" has never
failed to demonstrate choanal patency even when, in 2 cases, not only
the 6-Fr catheters but also the thinner and softer (but more expensive)
nasojejunal feeding tubes had failed to probe the newborn's nares.
Delivery room baby examiners might find this simple test
to which, to
the best of our knowledge, there is no previous reference in the
literaturea practical aid in their clinical work.
Antonio Capasso
Letizia Capasso
Francesco Raimondi
Domenico Perri
Roberto Paludetto
Division of Neonatology
Department of Pediatrics
University "Federico II"
Naples, Italy
REFERENCES
-
Hengerer AS, Yanofsky SD. Congenital malformations of
the nose and paranasal sinuses. In: Bluestone CD, Stool SE, Kenna MA,
eds. Pediatric Otolaryngology. Philadelphia, PA: WB Saunders
Company; 1996:831-842
-
Guzzetta PC, Anderson KD, Eichelberger MR. General surgery.
In: Avery GB, Fletcher MA, MacDonald MD, eds Neonatology:
pathophysiology and management of the newborn. Philadelphia, PA:
Lippincott; 1994:918-919
-
Robertson NRC. Resuscitation of the newborn. In:
Rennie JM, Robertson NRC, eds. Textbook of
Neonatology. Edinburgh, Scotland: Churchill Livingstone;
1999:241-265
Pediatrics (ISSN 0031 4005). Copyright ©2001 by the American Academy of Pediatrics
