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When a newborn’s heart rate stays below 60 beats per minute after initial ventilation, the next step is to perform chest compressions together with positive-pressure ventilation in a 3:1 ratio. This means three compressions for every breath, about 90 compressions and 30 breaths per minute. The goal is to improve both oxygen delivery and blood flow, since bradycardia in a newborn signals poor perfusion and hypoxemia. Ventilation without compressions won’t sufficiently boost circulation, and compressions alone won’t oxygenate the blood. Epinephrine is considered later if there’s no improvement after CPR and ventilation, but the immediate recommended action is the 3:1 PPV/compressions sequence.