Pediatric life support, resuscitation guideline updates developed by AAP, AHA

 

Pediatric life support, resuscitation guideline updates developed by AAP, AHA Free

October 22, 2025

Steve Schering, Staff Writer

Cardiology Fetus/Newborn Infant Patient Education/Patient Safety/Public Education Pulmonology

Updates on umbilical cord clamping and CPR recommendations for infants and children in cardiac arrest are among resuscitation guidelines released today by the AAP and American Heart Association (AHA).  

The 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (ECC) are published in Circulation and in the January issue of Pediatrics. The co-developed chapters include neonatal resuscitation, pediatric basic life support and pediatric advanced life support. 

 

The 2025 update is the first time pediatric- and neonatal-focused CPR and ECC guidelines were developed through an equal partnership between the AHA and AAP. The three chapters — Pediatric Advanced Life Support, Pediatric Basic Life Support and Neonatal Life Resuscitation — were co-led by experts from both organizations.  

“The result is not just one organization’s perspective but a unified set of recommendations that reflect the shared expertise, dedication and vision of both,” said Javier J. Lasa, M.D., FAHA, FAAP, associate professor in critical care and cardiology at Children’s Health in Dallas and co-chair of the 2025 Pediatric Advanced Life Support Writing Group. “We’re also proud that these guidelines will be jointly published in Circulation and Pediatrics, underscoring our joint commitment to advancing pediatric and neonatal resuscitation — together.”  

Neonatal resuscitation 

Approximately 5%-10% of newborns need help to begin breathing at birth, and about 1% need advanced resuscitation measures to restore cardiorespiratory function. Providing effective ventilation is the most critical step of neonatal resuscitation.  

“Our group reviewed the science that had been developed by the International Liaison Committee on Resuscitation, as well as performed our own review to produce the updated 2025 neonatal resuscitation guidelines,” said Henry C. Lee, M.D., FAAP, professor of pediatrics and a neonatologist at the University of California San Diego and co-chair of the 2025 Neonatal Writing Group. “A new feature is the Newborn Chain of Care that frames the context in which effective neonatal resuscitation can occur. The neonatal resuscitation algorithm has been updated to reflect the latest scientific knowledge, including for umbilical cord management and oxygen use.”  

The Newborn Chain of Care starts with prenatal care and extends into recovery and appropriate follow-up in the postnatal period to ensure optimal short- and long-term health for the infant and family.  

Updated guidance on umbilical cord management includes: 

• For term newborns who do not require immediate resuscitation, umbilical cord management has been updated. For those infants, deferred cord clamping for at least 60 seconds can result in improved hematologic indices and iron status compared to immediate cord clamping, authors say. 
• For nonvigorous term newborn infants and late preterm infants 35 weeks’ or more gestational age, intact cord milking may be reasonable when compared to immediate cord clamping. For newborn infants born at less than 37 weeks of gestation who do not require immediate resuscitation, deferred cord clamping for at least 60 seconds is recommended.  

Updates on ventilation rates and peak inflation pressure include: 

• Ventilation and continuous positive airway pressure updates for newborns call for initial peak inflation pressures of 20-30 cm H₂0 as reasonable, with adjustment of peak inflation pressure to provide effective ventilation. It is reasonable to provide ventilation at a rate of 30-60 inflations per minute in newborns.  

Pediatric basic life support  

Every year, more than 7,000 out-of-hospital cardiac arrests (OHCA) and approximately 20,000 in-hospital cardiac arrests occur in U.S. infants and children.  

Given the poor outcomes for pediatric OHCA, resuscitation can be improved in all phases of care. Authors note coordinated efforts by medical professionals, lay responders, emergency dispatchers and first responders are needed to increase chances of survival.  

Updated and new guidelines for delivering high-quality CPR include: 

• For infants and children in cardiac arrest, interruptions in CPR should be minimized and pauses in chest compressions should be less than 10 seconds.  
• For infants, rescuers should compress the sternum with the heel of one hand or two thumbs encircling hands technique. If the rescuer cannot physically encircle the chest, compressing the chest with the heel of one hand is recommended.  

Foreign body airway obstruction (FBAO) updates include:  

• For children with severe FBAO, repeated cycles of five back blows alternating with five abdominal thrusts should be performed until the object is expelled or the child becomes unresponsive. Rescuers should activate the emergency response system.  
• For infants with severe FBAO, repeated cycles of 5 back blows alternating with 5 chest thrusts is recommended. Abdominal thrusts are not recommended in infants.   

Pediatric advanced life support 

Medications given during pediatric cardiac arrest have been updated, including changes in class of recommendation for several medications. For the first time, the guidelines include information on predicting favorable and unfavorable neurologic outcomes after cardiac arrest.  

Drug administration during cardiac arrest:  

• For infants and children in cardiac arrest with initial non-shockable rhythm, it is reasonable to administer the initial dose of epinephrine as early as possible.  

Measuring physiology during CPR:  

• For infants and children with invasive airways in place during CPR, end-tidal carbon dioxide (ETCO₂) monitoring may be considered to monitor CPR quality.  
• A specific ETCO₂ cutoff value alone should not be used as an indication to end resuscitative efforts in infants and children.  
• For infants and children with continuous invasive arterial blood pressure monitoring in place during CPR, it may be reasonable for health care professionals to target diastolic blood pressure of ≥25 mmHg in infants and ≥30 mmHg in children 1 year of age and older.  

Treatment of supraventricular tachycardia (SVT) with a pulse:  

• For infants and children with SVT and a cardiopulmonary compromise unresponsive to vagal maneuvers, adenosine and electrical synchronized cardioversion and for whom expert consultation is not available, it may be reasonable to consider IV procainamide, amiodarone or sotalol.  

During post-cardiac arrest management, it is recommended to maintain systolic and mean arterial blood pressure greater than the 10th percentile for age.  

Other updates 

The guidance also recommends starting CPR training in children younger than age 12 to increase willingness and self-confidence in later years.  

More education and public awareness are needed to enhance cardiac arrest outcomes across racial, ethnic and low-socioeconomic populations.  

The AAP and AHA have also released, in conjunction with the guidelines, updates to the educational programs for Pediatric Advanced Life Support (PALS) and the 9th Edition of the Neonatal Resuscitation Program (NRP). 

The guidelines are being released in a livestream event from the International Liaison Committee on Resuscitation meeting in Rotterdam, Netherlands on October 22, 2025 beginning at 6 a.m. CST. Additional webinars are planned to provide further discussion on the changes to the guidelines and educational courses: 

• From Guidelines to Practice: Pediatric Basic and Advanced Life Support + PALS Course Updates 
• New Edition, Trusted Mission: What’s new in the NRP 9th Edition 

Resources 

• Neonatal Resuscitation Program 
• Pediatric Advanced Life Support Program