What is the next step if chest compressions do not change the heart rate of a newborn who is being ventilated?

In the scenario where chest compressions are ineffective at changing the heart rate of a newborn who is being ventilated, the appropriate next step is to establish intraosseous (IO) access. This is crucial because it provides a rapid route for administering medications if the heart rate remains unresponsive.

Newborns experiencing poor perfusion or bradycardia that do not respond to ventilation and chest compressions may require medication, such as epinephrine, to facilitate improved cardiac function and help restore a normal heart rate. However, medications cannot be given effectively without establishing access, especially in emergency situations where intravenous access may not be readily available or feasible.

While continuing ventilation, administering epinephrine, or providing supplemental oxygen may be appropriate in different contexts, they do not directly address the need for immediate medication delivery. Establishing IO access allows for the quick administration of necessary treatments while continuing CPR measures. Therefore, this step is critical for effective intervention in a newborn resuscitation scenario where chest compressions alone have not improved heart function.