Laryngeal atresia, an unexpected encounter of ‘cannot ventilate, cannot oxygenate’ at birth

Laryngeal atresia is a form of congenital high airway obstruction syndrome (CHAOS). It is a rare and often fatal condition. However, the unique characteristic features on antenatal ultrasound allow early diagnosis and the outcomes depend greatly on early interventions and effective resuscitation at birth.We described a case of twins with no antenatal suspicion of airway anomalies, presented with difficulty with ventilation and oxygenation at birth. The subject was later diagnosed with laryngeal atresia on postmortem examination. We performed a review of the case, the available literatures, and discussed on the management strategies when unexpected airway anomaly is encountered