In assessing a term infant in respiratory distress, which finding may suggest choanal atresia?

In the assessment of a term infant experiencing respiratory distress, the inability to pass a nasogastric tube down either nare is a critical finding that suggests the presence of choanal atresia. Choanal atresia is a congenital condition where the nasal passage is obstructed, preventing airflow through the nose. This obstruction can be unilateral or bilateral; however, if it's bilateral, it would lead to significant respiratory distress in the newborn, particularly during attempts to breathe, feed, or when sleeping.

The key aspect of this finding is that the nasogastric tube, when passed through the nostrils, fails to progress, indicating a blockage in the nasal cavity. This is a specific test that providers can perform to assess for the presence of choanal atresia and is one of the foundational evaluations in a newborn with suspected upper airway obstruction.

In contrast, while choking during feeds may indicate some form of respiratory or feeding difficulty, it does not specifically point to choanal atresia. Loud wheezing sounds typically suggest lower airway issues, such as asthma or bronchiolitis, rather than a structural anomaly like choanal atresia. Blue coloration of the skin (cyanosis) can occur in various respiratory distress scenarios, but it is