A failed neonatal resuscitation: Tracheal Agenesis

We describe a newborn with tracheal agenesis that was cyanosed at birth, with irregular breathing movements but without any audible cry. The color and heart rate improved only partially with mask ventilation. Repeated attempts at oro-tracheal intubation failed although, by inspection, the larynx and vocal cords looked normal. Cricothyrotomy with a size 16 intravenous cannula was attempted, but no air exchange could be produced and the child expired within one hour. This rare and under-recognized condition should always be considered when confronted with a neonate 'impossible to resuscitate' at birth. A review of the suggested approaches to manage affected infants highlights the lack of consensus on the management of this lethal condition. The possibility of antenatal diagnosis is reviewed.