Abstract
Congenital choanal atresia (CCA) is a rare congenital disease, and there are still fewer cases of bilaterality. For such cases, there are no detailed reports on the progress of suckling and sucking training or swallowing training focusing on bottle-feeding disorder which occurs immediately after birth. In this paper, we report the progress for about 1 year from beginning of sucking training in the Neonatal Intensive Care Unit (NICU) to the oral feeding stage.
The patient was a 3-month-old girl with bilateral complete CCA (atresia by bones), stricture palpebral fissure (left eye), anophthalmos, and left incomplete cleft lip. For the first 3 months, her SpO2 often dropped to about 30–80% irregularly. Head CT revealed a bone defect of the frontal cranial bone and the connection of intracranial and intranasal regions.
When she was 3 months old, she was in danger of choking caused by temporary apnea while sucking, lowering of SpO2, aspiration caused by subordination between sucking, swallowing and respiration, and lack of experience caused by no formal training of oral bottle-feeding. Since developing the ability to perform oral respiration she has been better and could drink milk from a feeding bottle at age 6 months old, and could take baby food once a day at age 7 months. Finally, when she was 1 year and 1 month old, she could have three meals a day the same as children with normal development.
Because newborn infants live by only nasal respiration for a few weeks and it takes a few weeks to learn how to perform oral respiration, it is fatal if they cannot perform nasal respiration. So, when faced with a case which has a risk of dying by dyspnea or cyanosis by nature such as reported here, it is important to carry out suckling and sucking training or swallowing training carefully with continuous assessment of coordination between sucking, swallowing, and respiration, danger of choking, and SpO2 value. In addition, this case reveals that in cases of bottle-feeding disorder or dysphagia requiring intervention in the NICU, a team approach with close cooperation among many specialists is very important, because there are many points and trends to be checked
