<prompt> A new bom child presented with CHD has cyanosis, become prominanat on breathing and improved in crying. The Diagnosis isBilateral choanal atresiaDiaphragmatic herniaGenitourinary defectsColoboma  <response>: i.e. Bilateral choanal atresia : 336-Ghai 7th 178-458-Dhingra 5th Affected baby cycles between spells of cyanosis and crying. Attempts at suckling immediately precipitates cyanosis in CHOANAL ATRESIACHOANAL ATRESIA More often unilateral. More common in female 2:1, more often on the right side and more often bony than membranous 9:1 Due to persistance of bucconasal membrane Bilateral choanal atresia usually presents immediately after birth with respiratory distress which is due to the fact that neonates are obligate nose-breathersSometimes babies bom with choanal atresia also have other abnormalities:ColobomaHeart defectsMental retardationGrowth impairmentOthers see also CHARGE syndromeAlso any condition that causes significant depression of the nasal bridge or midface retraction can be associated with choanal atresia. Examples include the craniosynostosis syndrome such as Crouzon syndrome, and Antley- Bixler syndrome. Diagnosisi Presence of mucoid discharge in the noseii Absence of air bubbles in the nasal dischargeiii Failure to pass a catheter from nose to pharynxiv Putting a few drops of a dye methylene blue in to the nose and seeing its passage into the pharynxv Installing - radio - opaque dye into the nose and taking a lateral film Bilateral choanal atresia requires - Urgent management by inserting a finger in the babys mouth: this can be replaced by with a plastic oropharyngeal airway or a Me Govern nipple - Failure - Endotrachial tube or tracheostomy Bilateral atresia can be associated with other syndrome head and neck abnormalities eg CHARGE association Coloboma, hearing impairment, choanal atresia, mental retardation, genital abnormality, endocardial cushion defects meningo-myelocoeles, craniosynostosis etc. Most patient with CHARGE syndrome have mutation in CHD7 gene. Mitomycin C has been used to present the development of granulation tissue stenosis 1743-Nelson 18thDiaphragmatic hernia - occurs because offailure of closure of the pleuroperitoneal membrane - at birth presented with respiratory distress and a scaphoid abdomen and mediastinal shift 