For a newborn presenting with central cyanosis and a heart rate of 90, what is the initial action?

In the scenario of a newborn exhibiting central cyanosis and a heart rate of 90 beats per minute, the most appropriate initial action is to provide positive pressure ventilation (PPV) with room air, which is 21% oxygen.

When a newborn shows signs of central cyanosis, it indicates that the baby's tissues are not receiving adequate oxygen, which can occur due to inadequate breathing or other respiratory problems. Given the heart rate of 90, which is below the normal threshold for newborns (100-160 bpm), it is critical to address the hypoxia immediately.

Starting positive pressure ventilation with room air is essential to improve oxygenation and ventilation. This intervention can quickly provide the necessary oxygen to the newborn's lungs and help alleviate the cyanosis by ensuring that adequate oxygen is being delivered to the alveoli for gas exchange.

In contrast, beginning chest compressions is typically reserved for a newborn with a heart rate less than 60 beats per minute, indicating more severe bradycardia and lack of cardiac output. Administering intravenous fluids is not the first response in this situation, as it does not directly address immediate respiratory needs. Positioning for airway management might be necessary, but the priority should focus on providing adequate ventilation to counteract low