Cardiopulmonary arrest in infants is rarely a sudden event. Rather, it is often the end result of a progressive deterioration in respiratory and circulatory function. Both shock and respiratory failure are usually preceded by a compensated state; however, infants can rapidly deteriorate from such states. Therefore, early signs of respiratory and circulatory failure must be promptly detected and treated so that cardiorespiratory arrest is prevented.
Deterioration in respiratory function or possible respiratory arrest should be anticipated in infants who demonstrate any of the following signs: an increased respiratory rate or effort; inadequate respiratory rate, effort, or chest excursion; decreased breath sounds; diminished level of consciousness or response to pain; poor skeletal muscle tone; or cyanosis (Todres & Fugate, 1996). Early shock is diagnosed by evaluation of heart rate, presence and volume (strength) of peripheral pulses, and adequacy of end-organ perfusion. Sustained sinus tachycardia may be an early sign of cardiovascular compromise. Bradycardia, by contrast, may be a preterminal cardiac rhythm. When cardiac output and systemic perfusion are compromised, the volume (strength) of peripheral pulses is decreased, capillary refill time may be prolonged, and skin temperature is often cool, although the skin temperature may be warm in septic patients.
With respect to poor infant weight gain, if the infant is otherwise well, simple interventions may solve the problem while promoting breast-feeding success (Todres & Fugate, 1
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