Cardiac arrest in infants and children remains a leading cause of pediatric emergencies, with more than 7,000 out-of-hospital and 20,000 in-hospital cardiac arrests occurring annually in the United States. Early recognition, rapid response, and high-quality cardiopulmonary resuscitation (CPR) are critical for survival, yet the needs of children differ significantly from adults. To address these distinctions and strengthen clinical preparedness, updated guidelines have been released outlining the latest evidence-based recommendations for pediatric and neonatal resuscitation.

The update has been jointly issued by the American Academy of Pediatrics (Itasca, IL, USA) and the American Heart Association (Dallas, TX, USA). This marks the first major revision of pediatric basic and advanced life support and neonatal resuscitation guidance since 2020. The updated recommendations are designed for use across community, prehospital, and hospital settings, guiding both healthcare professionals and lay responders.

Experts from both organizations co-led the three key chapters—Pediatric Advanced Life Support, Pediatric Basic Life Support, and Neonatal Resuscitation—ensuring equal representation from each body. Among the major pediatric updates, the guidelines establish a single, unified chain of survival for adults and children in both in-hospital and out-of-hospital cardiac arrest, emphasizing prevention, preparedness, and early intervention.

The revisions highlight the importance of early recognition, immediate activation of emergency services, and high-quality CPR beginning with chest compressions. For foreign body airway obstruction (FBAO), infants should now receive repeated cycles of five back blows alternating with five chest thrusts, while children should receive five back blows alternating with five abdominal thrusts—a change from prior recommendations.

For infant chest compressions, rescuers are now advised to use either the one-hand or two-thumbs encircling hands technique, while the outdated two-finger method has been removed due to insufficient depth. These refinements ensure improved efficacy and ease of application for both professionals and bystanders.

The neonatal chapter introduces a newborn chain of care—distinct from the general chain of survival—that begins with prenatal care and extends through postnatal recovery and follow-up. The recommendations call for deferred cord clamping for at least 60 seconds (up from 30 seconds previously) and underscore effective ventilation as the top priority in newborn resuscitation. Health care professionals are urged to anticipate potential complications and work in coordinated teams trained in neonatal resuscitation practices.

Additional neonatal updates include ventilation at a rate of 30–60 inflations per minute (broadened from 40–60), along with updated best practices for chest compression positioning, pulse oximeter placement, and ventilation corrective steps. The document, titled “2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care,” has been published in both Circulation and Pediatrics.

"The guidelines also observe that one out of every 10-20 newborns each year needs help transitioning from the fluid-filled environment of the womb to the air-filled room,” said Dr. Henry Lee, co-chair of the Neonatal Writing Group. “It is essential that every newborn infant has a health care professional dedicated to facilitating that transition who is trained and equipped for the role using these recommendations.”

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