For a newborn with a heart rate less than 100 bpm and poor respiratory effort or persistent central cyanosis, which action should be added if cyanosis persists despite correct BVM technique?

• A. Ventilate with BVM on room air
• B. Add high-flow O2 15 L/min to BVM
• C. Stop BVM when pulse returns
• D. Begin chest compressions

Answer: (B)

When a newborn shows persistent cyanosis despite correct ventilation with a bag‑mask, the issue is inadequate oxygen delivery. Increasing the inspired oxygen concentration helps lift oxygen saturation quickly. Delivering high‑flow oxygen with the bag‑mask, about 15 L/min, pushes more O2 into the lungs and improves arterial oxygenation, which can in turn improve heart rate and perfusion. Stopping ventilation when a pulse returns isn’t appropriate during ongoing resuscitation, and chest compressions are only indicated if the heart rate remains below critical levels after effective ventilation with adequate oxygen.