Conclusions

This case suggests that small stomach may be an observational prenatal finding for associated esophageal obstruction, prompt evaluation of the upper airway, especially in the setting of normal amniotic fluid. A high degree of suspicion for CHAOS should guide management in neonates presenting with severe respiratory distress and failed intubation. When difficulty with intubation is anticipated, early consultation with otolaryngology should be considered so that a team capable of performing a surgical airway is immediately available if required. While the small stomach is only an observational finding, it may offer insight for future cases and guide clinical consideration in similar scenarios.