What is the appropriate response after 30 seconds of BVM ventilation if a newborn's heart rate is less than 60?

When a newborn's heart rate is less than 60 beats per minute despite providing positive pressure ventilation with a bag-valve-mask (BVM) for 30 seconds, the appropriate action is to initiate cardiopulmonary resuscitation (CPR) at a rate of 120 compressions per minute. This response is critical because a heart rate below 60 in a newborn is considered bradycardia, which indicates inadequate oxygenation and a compromised circulatory status.

By starting CPR, you can help restore blood flow and oxygen delivery, which is vital for the newborn's survival. The guideline to perform compressions at a ratio of 3:1 with ventilations (in the absence of advanced airway management) during neonatal resuscitation emphasizes the need for rapid and effective action to improve the heart rate and breathing.

Supplemental oxygen delivery alone would not address the underlying issue of insufficient circulation, and simply reassessing the airway may not provide the immediate intervention required for the low heart rate. Increasing the ventilation rate without addressing the poor perfusion through chest compressions also falls short of the necessary immediate actions for a newborn with bradycardia. Hence, initiating CPR at the right rate is the most appropriate and critical intervention in this situation.