Neonatal respiratory distress from rhinitis medicamentosa

Rhinitis medicamentosa from topical vasoconstrictor abuse results in nasal obstruction which can be life-threatening in neonates. Neonates are obligate nasal breathers, most learning oral respiration by 2 months of age. A neonate was started on topical phenylephrine at birth, and by 3 weeks of age was having multiple daily episodes of apnea and cyanosis. An evaluation documented edematous, obstructing nasal turbinates, as well as polycythemia, cardiomegaly, and prominence of the pulmonary vasculature. A nasopharyngeal airway alleviated the obstruction until the turbinates recovered, and the other abnormalities quickly resolved.