What would be the first action when a newborn presents with a heart rate below 60 beats/min?

In the context of neonatal resuscitation, when a newborn presents with a heart rate below 60 beats per minute, the first action should be to initiate positive pressure ventilation. This is crucial because a heart rate below this threshold typically indicates inadequate oxygenation or ventilation. Positive pressure ventilation helps to deliver adequate oxygen to the lungs, which can improve circulation and assist in raising the heart rate.

Providing effective ventilation is paramount, as it can correct the hypoxia that is causing the bradycardia. The immediate focus is to ensure that the newborn is adequately oxygenated, which can prompt an increase in heart rate.

Other measures, such as starting chest compressions or administering medications like epinephrine, are generally reserved for situations where ventilation does not lead to an improvement in heart rate after a brief period. Reassessing the airway is important, but the priority remains on restoring adequate ventilation, which indicates why starting with positive pressure ventilation is the appropriate first step in this scenario.