After initiating resuscitation steps, a newborn remains apneic and cyanotic. What should be done next?

In the scenario where a newborn is apneic and cyanotic despite the initiation of resuscitation steps, the next critical action is to begin ventilations with a bag-valve-mask. This step is essential because the newborn is not breathing adequately on their own, which is indicated by the absence of effective spontaneous respirations leading to cyanosis. Providing positive pressure ventilation will help to establish adequate oxygenation and ventilation, potentially reversing the harmful effects of hypoxia.

Ventilating the newborn with a bag-valve-mask allows for the delivery of oxygen directly into the lungs, which is crucial in addressing both the apneic condition and the associated cyanosis. This intervention should occur promptly to effectively provide life-sustaining support while monitoring the newborn's heart rate and overall response.

Other actions, while they may have their place in different resuscitation scenarios, are not the immediate priority. For example, suctioning the mouth and nose could be appropriate if there were visible secretions obstructing the airway but should not be prioritized over ventilations in this case. Flicking the soles of the feet might stimulate a response but is not an effective method for establishing respiratory function. Starting CPR is reserved for situations where the heart rate is critically low, but