An infant (under one year old) who is not breathing normally but has a detectable pulse is experiencing a respiratory emergency. This is the most common cause of cardiac arrest in this age group. Due to infant physiology, a lack of oxygen quickly leads to heart problems if not corrected immediately. The primary goal is to provide oxygenation quickly to stabilize the infant until professional help arrives.
Recognizing Signs of Respiratory Failure
Respiratory failure presents with clear visual and auditory distress signals indicating the body is struggling to maintain proper oxygen levels. A bluish tint, known as cyanosis, may appear, most noticeable around the lips, mouth, and under the fingernails. This color change occurs because the blood lacks sufficient oxygen saturation.
Physical signs of distress include retractions, where the skin visibly sucks in between the ribs or below the breastbone with each breath. This indicates the infant is using accessory muscles to expand the lungs. Nasal flaring, where the nostrils widen during inhalation, is another attempt to draw in more air.
Infants may also exhibit grunting, a sound produced as they breathe out to keep the air sacs open. As failure progresses, the infant may become noticeably lethargic, weak, or unresponsive. These signs signal a need for urgent intervention.
Immediate Rescue Breathing Protocol
If an infant is unresponsive and not breathing but has a pulse, initiate rescue breathing immediately. First, call for help or activate the emergency medical services (EMS) system. Place the infant on a firm, flat surface and check the pulse for no more than ten seconds, typically at the brachial artery.
To open the airway, use the head-tilt/chin-lift maneuver, gently tilting the head back only slightly. Overextending the neck can block the airway. The rescuer must create a seal over both the infant’s mouth and nose with their own mouth. Each breath should be a gentle puff, lasting about one second, with enough volume to make the chest visibly rise.
The correct rate for rescue breathing is one breath every two to three seconds, translating to 20 to 30 breaths per minute. This pace rapidly corrects the oxygen deficit. After delivering approximately two minutes of rescue breathing, the pulse must be reassessed. If the pulse continues, the focus remains solely on providing ventilations.
When to Transition to Full CPR
Although the heart is beating during rescue breathing, lack of oxygen can cause the heart rate to slow drastically. Transition to full cardiopulmonary resuscitation (CPR) is triggered if the pulse rate is lost entirely or drops below 60 beats per minute (BPM). A heart rate below this threshold indicates circulation is inadequate to sustain the body’s oxygen needs.
Once the pulse falls below 60 BPM or is absent, chest compressions must be added to circulate oxygenated blood manually. For a single rescuer, use two fingers placed on the breastbone just below the nipple line. Compress the chest about 1.5 inches deep, or approximately one-third the depth of the chest. The compression rate should be fast, aiming for 100 to 120 compressions per minute, ensuring full chest recoil.
The compression-to-breath ratio for a single rescuer performing full CPR is 30 compressions followed by two rescue breaths. Minimizing interruptions to chest compressions is paramount, as maintaining blood flow is the priority alongside oxygen delivery. Continue this combined cycle until emergency medical services arrive or until the infant shows definite signs of life.
Post-Emergency Stabilization and Care
Once emergency medical services take over, the infant will be transferred to a medical facility, typically a pediatric intensive care unit (PICU). This phase focuses on stabilizing the infant and identifying the underlying cause of the respiratory event, which could range from infection, choking, or congenital conditions. Immediate medical management involves continuous monitoring of the infant’s vital signs, including blood pressure, heart rate, and temperature.
Hospital staff will perform diagnostic tests, such as arterial blood gas analysis to measure oxygen and carbon dioxide levels, and chest X-rays to assess the lungs. Targeted temperature management may be initiated to protect the brain from injury caused by the period of oxygen deprivation. The medical team monitors the infant’s neurological status and organ function, adjusting oxygen delivery and medications to support recovery.