The nurse notes the 4-day-old infant develops circumoral cyanosis while breastfeeding. Once the seal is broken and the neonate begins to cry, the cyanosis resolves and the child becomes pink. There are no nasal secretions and the neonate’s vitals are normal. Which action by the nurse is most helpful?

Question

The nurse notes the 4-day-old infant develops circumoral cyanosis while breastfeeding. Once the seal is broken and the neonate begins to cry, the cyanosis resolves and the child becomes pink. There are no nasal secretions and the neonate&rsquo;s vitals are normal. Which action by the nurse is most helpful?

Accepted Answer

Attempt to pass a nasogastric tube through each naris. Circumoral cyanosis while breastfeeding that resolves with crying is the classic symptom of choanal atresia, which is an obstruction of the nasopharynx. Attempting to pass a nasogastric (NG) tube is helpful because it is ruled out if the NG tube is able to be passed. Instilling saline into the nares then suctioning the nares is not the most helpful intervention because the patient has not had secretions. Although a critical congenital heart disease screening needs to be performed prior to discharge, this intervention does not address the circumoral cyanosis that occurs during feeding. Although a brisk letdown and large breastmilk supply can overwhelm some infants, partially emptying the breast prior to breastfeeding will not help in this situation.

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