Cardio-respiratory Arrest in Newborns

When a newborn’s heart and breathing stop, immediate action can save a life. Understanding how cardio-respiratory arrest happens in the youngest patients and knowing the proper response can make the difference between life and death.

Table of contents

• What Is Cardio-respiratory Arrest in Newborns
• How Often This Occurs
• Why It Happens
• Recognizing the Signs
• Resuscitation and Emergency Care
• Survival and Recovery

What Is Cardio-respiratory Arrest in Newborns

Cardio-respiratory arrest in newborns, also called neonatal cardiopulmonary arrest, occurs when a baby’s heart stops beating effectively and breathing ceases. This is a medical emergency where the baby’s body can no longer deliver oxygen to vital organs^[2].

In newborns, this condition looks different from cardiac arrest in older children and adults. Rather than being primarily a heart problem, it usually results from difficulty with breathing or the baby’s transition from life in the womb to breathing air^[7].

How Often This Occurs

Approximately 10% of newborn babies need some help with breathing at birth. However, fewer than 1% require extensive emergency measures to restart their heart and breathing^[19].

About one out of every 10 to 20 newborns needs assistance transitioning from the fluid-filled environment of the womb to breathing air in the outside world. This makes it essential that every delivery has a healthcare professional present who is trained and equipped to help newborns who struggle with this transition^[5].

The risk of needing resuscitation increases significantly when babies are born weighing less than 1,500 grams (about 3.3 pounds)^[13].

Why It Happens

Unlike in adults where heart problems often cause cardiac arrest, newborns typically experience cardio-respiratory arrest due to breathing difficulties or problems with the transition to life outside the womb^[7].

Several conditions can lead to this emergency situation in newborns. These include problems with the baby’s airway being blocked, conditions affecting the lungs or chest, abnormalities of the brain or spinal cord that affect breathing, and certain heart defects present at birth^[19].

Factors related to the mother’s health and pregnancy can also increase risk. These include complications during pregnancy such as diabetes, high blood pressure, or preterm delivery. Problems during labor and delivery, such as the umbilical cord being compressed or bleeding, can also trigger cardio-respiratory arrest in a newborn^[19].

Recognizing the Signs

Newborns experiencing cardio-respiratory arrest show specific warning signs. The baby may have apnea, which means they are not breathing at all. They may also have a very slow heart rate, called bradycardia, with fewer than 100 beats per minute^[7].

Other signs include the baby being limp and unresponsive (called hypotonia) and having a bluish color to the skin, especially in the center of the body. This blue coloring, known as central cyanosis, indicates the baby is not getting enough oxygen^[7].

Resuscitation and Emergency Care

The American Heart Association and American Academy of Pediatrics have published updated guidelines specifically for resuscitating newborns. These guidelines were most recently updated in 2025 and provide detailed instructions for healthcare professionals^[5].

The first step in helping a newborn who is not breathing is to provide assisted breathing, called positive pressure ventilation. If the baby’s heart rate remains below 100 beats per minute after this initial help, healthcare providers must begin more advanced measures, including chest compressions^[20].

Every delivery should have at least one healthcare professional present who is skilled in the initial steps of neonatal resuscitation, including giving positive pressure ventilation. Additional trained personnel with the ability to perform more advanced procedures should be immediately available^[19].

The guidelines emphasize that care must begin within the first 60 seconds after birth if a baby does not start breathing on their own. This rapid response is critical for the best possible outcome^[20].

Survival and Recovery

The outcome after neonatal cardio-respiratory arrest depends largely on how quickly effective care begins. Studies have shown that mortality rates for cardiac arrest in babies can be very high, particularly when the arrest occurs outside of a hospital setting^[13].

For babies who experience cardiac arrest in the hospital, approximately 65% do not survive. When the arrest involves only breathing problems without the heart stopping completely, the mortality rate is lower, at 20 to 25%^[13].

Even when babies survive, their neurological outcome—meaning how their brain functions afterward—can be significantly affected. This is why prevention, early recognition, and immediate high-quality care are so important^[13].

Recent research has identified opportunities to improve outcomes through better post-arrest care in neonatal intensive care units. One study found a high rate of low body temperature in babies after cardiac arrest, along with significant variation in how these babies are monitored and treated. This highlights the need for more specific guidelines for caring for newborns after their heart and breathing have been restarted^[12].