Airway obstruction by foreign bodies is rarely encountered in the neonatal intensive care unit. The majority of those cases reported are iatrogenic. This paper reports a case of acute airway obstruction in a preterm infant caused by a sheared plastic sheath of an endotracheal intubation stylet used during tracheal intubation. The small airway of this premature infant posed a challenge to retrieve the foreign body and to ensure adequate gas exchange at the same time. The risks and benefits of available therapeutic options for this rare, but serious complication are reviewed.