If this has not already been done in the delivery room, patency of the nasopharynx is determined by passing a soft, sterile, 6-French catheter through each external naris and advancing it into the posterior nasopharynx. This test rules out the presence of unilateral or bilateral choanal atresia, which is a cause of severe respiratory distress in newborns. Newborns are nasal breathers, and obstruction to nasal flow can cause considerable distress;the infant with nasal obstruction is cyanotic and distressed at rest, but the cyanosis diminishes when he or she cries. Choanal atresia may occur as an isolated anomaly (in which case, more than 90% of affected individuals are female), or it may be part of the CHARGE syndrome, which was mentioned in the discussion of iris colobomas.

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