A newborn presents with a thin hairlike fiber connecting the medial aspect of her upper and lower eyelids vertically (Fig 1).

The infant was doing well on nasal CPAP upon arrival to the NICU. However, she would develop respiratory distress upon discontinuation of CPAP mask. The nursing staff reported difficulty passing a nasogastric feeding tube, raising a suspicion of choanal atresia.

The admitting house staff and nurse noted a thin threadlike tissue connecting the eyelids vertically. This was initially thought to be a strand of hair, but could not be rubbed off by wiping.

During the course of her stay in the NICU, she failed support with CPAP. She was intubated and transitioned to mechanical ventilation on her first day after birth. Choanal atresia was confirmed on computed tomography scan and subsequently a tracheostomy tube was placed as desired by the family. Echocardiography revealed large ventricular septal defect,...

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