What action should you take if a newborn requires a positive pressure ventilation and is still not breathing effectively after 30 seconds?

In cases where a newborn requires positive pressure ventilation and remains ineffective in breathing after the initial 30 seconds, beginning chest compressions immediately is essential. This immediate action is guided by the resuscitation protocols for newborns.

When a newborn is not responding to ventilation, it indicates possible compromise of respiratory and circulatory function. According to the guidelines, after providing adequate ventilation for 30 seconds without improvement, the priority shifts to ensuring effective circulation. Chest compressions can help maintain blood flow and oxygen delivery to vital organs, particularly the heart and brain. The standard approach involves initiating compressions at a rate of 90 compressions per minute, while providing ventilations in a 3:1 ratio.

Reassessing and continuing ventilation could be an alternative under specific circumstances, but if the newborn remains unresponsive to ventilation efforts, it is critical to escalate the intervention to include chest compressions to support the circulatory system.

Intubation is a possible next step if ventilation is unsuccessful, but it is usually reserved for more severe cases or when there are indications of significant airway obstruction that cannot be resolved with bag-valve-mask ventilation. Calling for additional assistance is also advisable, but immediate actions need to address the infant's vital signs comprehensively first.

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