A newborn who is cyanotic at rest but pink when crying most likely has which condition?

• A. Abnormally low nasal bridge
• B. Bilateral choanal atresia
• C. Deviation of the nasal septum
• D. Nasal polyps

Answer: (B)

The pattern points to nasal airway obstruction in a newborn who normally breathes through the nose. Newborns are obligate nasal breathers, so any blockage of both nasal passages causes cyanosis at rest. When the baby cries, mouth breathing is opened up and airflow bypasses the nasal passages, often turning the color pink. Bilateral choanal atresia fits this scenario perfectly because it blocks the nasal passages completely, and the infant becomes pink only when able to breathe through the mouth during crying.

Other nasal issues listed can cause obstruction, but they don’t produce the classic cyanosis that improves with crying in a newborn. Diagnosis is suggested when a catheter cannot pass through the nasal passages, with imaging used to confirm and plan surgical repair.