A solved case of bilateral choanal atresia in a 10 hour newborn allowed the authors to make some pathogenic, clinic and therapeutic considerations. The paper underlines the high severity of the disease, which imposes the need of a quick diagnosis and an emergency surgical procedure assuring the airway patency and proper ventilation. The transnasal endoscopic approach is the procedure of choice, being quick, safe, providing direct and excellent visualization of the nasal cavity and posterior choanae, and having less postoperative morbidity than other surgical procedures. It is also emphasized the need of general anaesthesia with VIMA technique, which covers all the requirements of the anaesthesia in newborn.