In which situation might a newborn exhibit a pink color when crying but appear cyanotic at rest?

A newborn who exhibits a pink color while crying but appears cyanotic at rest may be experiencing a condition known as choanal atresia. This condition is characterized by a blockage of the nasal passages, which can lead to significant respiratory distress, particularly when the infant is at rest and not actively crying. When the newborn cries, increased airflow can temporarily relieve the obstruction, resulting in a pink appearance due to improved oxygenation.

In the case of choanal atresia, infants typically have difficulty with breathing, especially while feeding or at rest, which can lead to cyanosis. However, crying can create a strong enough respiratory effort to allow for some oxygenation, leading to a transient pink color.

Other conditions, such as cardiac defects, pneumonia, or respiratory distress syndrome, would likely present with more consistent cyanosis due to their underlying pathophysiology, which typically affects oxygenation regardless of the activity level of the newborn. In these cases, the baby might not experience the same rapid change in color in response to crying as seen in choanal atresia.