Newborn nasal obstruction: Rare anatomical causes to consider

Neonatal nasal obstruction, though rare, can be life-threatening due to the obligate nasal breathing pattern in newborns. Even partial obstruction may compromise ventilation and feeding. This study aims to describe rare anatomical causes of neonatal nasal obstruction, highlighting their clinical presentation, diagnostic evaluation, and management. A retrospective review was conducted of four neonates with respiratory distress who were diagnosed with congenital nasal malformations through endoscopic examination and craniofacial imaging. The identified cases included bilateral choanal atresia in a patient with CHARGE syndrome, congenital nasal pyriform aperture stenosis (CNPAS) with a solitary median mega-incisor, isolated CNPAS with midnasal hypoplasia, and bilateral congenital dacryocystoceles. Symptoms ranged from noisy breathing to feeding intolerance. Management included both medical and surgical interventions depending on the severity of the obstruction. Although infrequent, anatomical nasal anomalies should be promptly considered in neonates presenting with respiratory distress, as early diagnosis and appropriate treatment are essential to avoid complications and ensure favourable outcomes.