What action should be taken if a newborn is apneic and has not responded to initial steps within the first minute?

When a newborn is apneic and has not responded to initial steps such as tactile stimulation within the first minute, the appropriate action is to begin positive pressure ventilation (PPV). This intervention is critical because it directly addresses the newborn's inability to breathe adequately on their own. The goal of PPV is to establish effective ventilation and improve oxygenation in the infant, which can help prevent further complications associated with hypoxia and respiratory failure.

Positive pressure ventilation delivers oxygen directly to the lungs, which is essential for infants who are not taking adequate breaths. This action can significantly improve the infant's condition by providing the necessary support to restore normal breathing and increase blood oxygen levels.

While continuing tactile stimulation could be beneficial, it may not be sufficient if the newborn is in severe distress and shows no response. Administering free flow oxygen can help in cases where the infant is breathing but is not adequate alone for an apneic infant. Preparing for intubation is a more invasive procedure and may not be immediately necessary if PPV can effectively support the newborn's ventilation needs in the initial resuscitation efforts.