Final answer:
Administer epinephrine to the apneic newborn with a persistently low heart rate of 40 bpm after effective PPV with chest movement but no heart rate increase. This aligns with neonatal resuscitation guidelines for bradycardia when advanced resuscitative measures are required.
Step-by-step explanation:
If you have started positive pressure ventilation (PPV) for an apneic newborn and the heart rate has remained at 40 despite performing all of the ventilation corrective steps and intubating, and seeing chest movement with additional PPV, but the heart rate remains at 40, the next step should be to administer epinephrine. This is in accordance with neonatal resuscitation guidelines recommending intervention for bradycardia (heart rate < 60 bpm) after adequate ventilation has been confirmed but the heart rate remains critically low. Moving to epinephrine is indicated because the persistent low heart rate suggests the need for further advanced resuscitative measures beyond ventilation alone.
According to the Apgar score, heart rate and respiration are the most critical criteria, with a total score below 5 indicating an emergency situation where immediate medical attention is needed. In the scenario described, after 30 seconds of effective PPV with chest movement but no increase in heart rate, moving directly to drug administration is the proper course of action. Ensuring high-quality chest compressions is also critical per resuscitation protocols if spontaneous heart activity does not resume.