Neonatal mortality remains a major health challenge across the world, which involves neonatal sepsis and other related factors of prematurity. Though many strides have been done in reducing NMR, there is a need for more appropriate interventions and strategies directed towards addressing the rise in the escalation of AMR. Combating AMR will be critical in improving neonatal survival rates while giving each newborn a healthier start into life globally.

The newborn period is the key period for infant health, and the first 28 days of life are critically important-both for survival and as a base to set lifetime health and development. Neonatal deaths globally have witnessed a significant decline over the past couple of decades. The neonatal mortality count has significantly reduced dropping from a high of 5 million in 1990 to as low as 2.3 million as of 2022. However, this decline notwithstanding, neonatal mortality is still staggeringly high across low-and middle-income nations.

Neonatal mortality rates are 22 per 1000 live births in India. Neonatal sepsis and prematurity are the main causes of neonatal deaths in these tragic events. Recognizing the gravity of the issue the Indian government started the Indian Newborn Action Plan (INAP) in 2014. The goal is to take NMR down to the single digits by 2030. This initiative has brought in several key interventions, including antenatal care (vaccines, micronutrient supplementation), skilled birth attendance, clean birth practices, and neonatal resuscitation techniques. More promisingly, postnatal interventions, including early initiation of breastfeeding and skin-to-skin contact, have been proven to work well in improving newborn survival rates.

Despite these improvements, one of the biggest concerns in neonatal care today is the growing problem of antimicrobial resistance (AMR) which seriously threatens efforts to reduce neonatal mortality.

What is Antimicrobial Resistance?

Antimicrobial resistance occurs when microorganisms such as bacteria, viruses and fungi evolve over time and become resistant to commonly used antibiotics and other medications. This resistance makes infections more difficult to treat, increasing the risk of mortality and complicating treatment options. The World Health Organization has classified AMR as one of the most urgent global health threats since it not only causes death and disability but also places immense pressure on healthcare systems, significantly raising the economic burden.

The sources of AMR are many, including poor hygiene and infection control in healthcare settings, overuse and misuse of antibiotics. Contributing factors to this rapidly growing problem are antibiotic prescriptions for patient needs that do not require them and failure to complete antibiotic courses, as prescribed.

AMR and Newborn Health

For neonates, the risk is much more vital for AMR. Neonates are particularly prone to developing infections due to their rather weak immune systems. Neonatal sepsis, severe bacterial infection, is one of the leading causes of neonate deaths and it often manifests complications when it is because of drug-resistant pathogens.

According to Dr. Apoorva Taduri, Consultant Neonatologist, "Neonatal sepsis accounts for a significant proportion of neonatal deaths, and AMR is making it worse. MDR pathogens cause around 30% of neonatal sepsis mortality globally.

Maternal health and care are also factors influencing AMR in neonates. Over-prescription of antibiotics during pregnancy increases the risk of neonatal sepsis and the development of multi-drug-resistant pathogens in newborns. This calls for prudent use of antibiotics during pregnancy and at the time of delivery. In fact, studies indicate that indiscriminate use of antibiotics in mothers has a direct impact on neonatal health, which may eventually lead to resistant infections in newborns.

One of the major issues is that the drug-resistant bacteria are causing an increasing number of healthcare-associated infections in the neonatal care settings, which include NICUs. Infections by such bacteria prove to be challenging to treat; they require more advanced, expensive interventions, and the period of risk of mortality and morbidity is extended.

Counteracting AMR in Neonatal Care

To combat AMR and reduce neonatal mortality a multifaceted approach is necessary. Dr. Taduri emphasizes the continuation of the strategies outlined by the Indian Newborn Action Plan (INAP), specifically in reducing neonatal sepsis and improving infection control. However, to combat AMR more must be done to ensure proper use of antibiotics in both maternal and neonatal care settings.

Key strategies for reducing AMR in neonatal care are:

1. Improving Infection Prevention Practice: This implies, therefore, that more efforts would be made regarding stricter hospital hygiene standards, strict equipment sterilization after its usage and even maintaining adequate hand hygiene. Enhanced infection control practices greatly impact minimizing AMR pathogens distribution.

2. Antibiotic Stewardship- Teaching the healthcare providers how not to use antibiotics is a crucial thing in preventing overuse prescription. Antibiotic stewardship programs are designed to promote use of antibiotics only when truly required; appropriate drug, dose and length of treatment should be taken.

3. Improved access to WASH: Access to clean water and sanitation is a fundamental aspect of preventing infections in mothers and newborns. WASH interventions such as clean birthing practices, can reduce the risk of neonatal sepsis due to unsanitary conditions.

4. Maternal Health Strengthening: Proper maternal care, such as proper vaccination, antenatal steroids, and supplementation of micronutrients, can reduce the risk of prematurity and neonatal infection. Prevention of infection in mothers is the first step towards prevention of infection in newborns.

5. Early Diagnosis and Treatment: Early identification and treatment of neonatal infections are very important. This includes proper screening for sepsis and the use of appropriate antibiotics based on the local resistance patterns. It also involves ensuring that infants receive adequate neonatal care, such as those provided in Special Newborn Care Units (SNCUs).

The rise of antimicrobial resistance is a global health challenge that requires urgent action. Combating AMR requires a coordinated effort from governments, healthcare systems and communities worldwide. In neonatal care, addressing AMR is essential to further reducing neonatal mortality rates and ensuring that every newborn has the opportunity to thrive.

As Dr. Taduri concludes, "While we have made substantial progress in reducing neonatal mortality, the emerging risk of antimicrobial resistance creates a major challenge for our efforts. Combating AMR requires a global collective effort, with priorities on infection prevention, responsible use of antibiotics, and enhancement of healthcare practices to ensure a healthier future for all newborns."

Dr Apoorva Taduri is a Consultant Neonatologist at Fernandez Hospital

Delhi's air quality has slipped into the 'poor' category for the first time in more than 85 days, even as the monsoon season sets in. While rainfall is often expected to clear the air, doctors warn that a combination of lingering pollution, high humidity, mold, allergens, and seasonal viral infections can significantly increase the risk of respiratory illnesses in children. Experts say children are especially vulnerable because their lungs and immune systems are still developing, making it easier for polluted air and environmental triggers to affect their breathing and long-term lung health.

After weeks of relatively clean air, Delhi's air quality deteriorated sharply on July 12, with the city's overall Air Quality Index (AQI) slipping into the 'poor' category at 261—the highest level recorded in more than 85 days.

According to Central Pollution Control Board (CPCB) data, this was the city's highest AQI since April 17, when it stood at 263.

Repeated exposure to polluted air during childhood can impair lung development and increase the risk of long-term respiratory diseases.

"Air pollution affects children more because their lungs are still developing, and they breathe faster than adults, inhaling more polluted air relative to their body weight," Dr. Narendra Kumar Jha, Director and Head of Pediatrics at Yashoda Medicity, told HealthandMe.

He added that inhaled pollutants irritate and inflame the airways, weakening the body's natural defense mechanisms. This can lead to chronic cough, wheezing, breathing difficulties, throat irritation, and worsening of conditions such as asthma and allergic rhinitis.

Why Children Are More Vulnerable

Children are not simply "small adults," said Dr. Nikhil Rajvanshi, Consultant, Pediatric Pulmonology, Madhukar Rainbow Children's Hospital, Delhi.

Because their lungs and immune systems are still developing, children breathe faster and inhale more air per kilogram of body weight than adults, making them more susceptible to pollution, infections, and environmental triggers.

How Air Pollution Affects Children's Lungs

According to Dr. Rajvanshi, pollutants such as PM2.5, PM10, nitrogen dioxide, and ozone penetrate deep into the lungs, triggering inflammation.

Even short-term exposure can cause:

• Coughing
• Wheezing
• Chest tightness
• Reduced exercise tolerance
• Increased emergency visits in susceptible children

Over time, repeated exposure can impair lung growth, reduce lung function, worsen asthma control, and increase the risk of chronic respiratory diseases later in life.

Why Respiratory Illnesses Increase During the Monsoon

Despite occasional rainfall clearing pollutants, the monsoon creates conditions that favor respiratory illnesses.

Dr. Rajvanshi explained that high humidity promotes indoor mold growth, damp conditions increase exposure to fungal spores, viral infections spread more easily, and sudden weather changes can trigger asthma. Periods of stagnant air between rainfall spells may also allow pollutants to accumulate.

As a result, pediatric clinics are reporting more cases of:

• Viral upper respiratory tract infections
• Persistent cough after viral illness
• Wheezing, especially in preschool-aged children
• Acute asthma attacks
• Allergic rhinitis with nasal blockage and sneezing
• Breathing difficulties linked to humidity, mold exposure, and fluctuating air quality

Children with asthma or allergies are particularly vulnerable, as viral infections combined with poor air quality can significantly worsen their symptoms.

How Parents Can Protect Their Children

Dr. Jha advised parents not to ignore persistent cough, breathing difficulty, or sleep disturbances caused by respiratory symptoms.

On days when pollution levels are high, children should avoid prolonged outdoor activities and strenuous exercise. Parents should also keep indoor air as clean as possible, ensure children stay hydrated, and continue prescribed asthma medications if needed.

Other preventive measures include:

• Monitor the daily AQI before outdoor activities.
• Keep children away from tobacco smoke, incense, mosquito coils, and indoor biomass smoke.
• Prevent dampness and mold inside the home.
• Clean regularly to reduce dust accumulation.
• Encourage frequent hand hygiene.
• Ensure adequate sleep, hydration, and a balanced diet.
• Continue prescribed controller medication and maintain an updated asthma action plan for children with asthma.
• Ensure eligible children, particularly those with chronic respiratory diseases, receive an annual influenza vaccination.

When Should Parents Seek Medical Care?

Parents should consult a pediatrician if a child develops:

• Fast or difficult breathing
• Wheezing or noisy breathing
• A cough lasting longer than two to three weeks
• Recurrent nighttime coughing
• Fever accompanied by breathing difficulty
• Poor feeding or lethargy in infants
• Bluish lips or fingertips
• Asthma symptoms that do not improve with prescribed reliever medication

Dr. Rajvanshi stressed that early medical evaluation can help distinguish between viral infections, asthma, allergies, pneumonia, and other lung conditions.

"Not every cough requires antibiotics, and not every episode of wheezing means a child has asthma. However, recurrent cough, persistent wheezing, exercise limitation, or breathing difficulty should never be ignored. Early diagnosis and appropriate treatment can prevent complications and improve long-term lung health," he told HealthandMe.

The adolescent stage is a crucial milestone in one’s life due to various developments experienced by teenagers at this stage. Adolescents must get access to comprehensive reproductive health education because it is instrumental in educating them on various health concerns, enabling them to develop healthy lifestyles.

Nonetheless, due to social taboos, myths, and insufficient information, adolescents find themselves in a situation where they are not conversant with health concerns.

Creating Awareness About PCOS and Menstrual Health

Among some of the things that need to be discussed in relation to adolescent reproductive health is the issue of Polycystic Ovary Syndrome (PCOS) and menstruation. Today, there is a higher prevalence of PCOS among girls and young women than before, which is related to various complications, including irregular menstruation, acne, excess body hair, and obesity problems in the future. It is important to know the first signs of PCOS to make a quick diagnosis of the disease and bring about lifestyle changes.

Another aspect that should be taken into account is the promotion of menstrual hygiene among girls. Girls need to understand that menstruation is a natural phenomenon that, therefore, nothing should prevent them from practicing good menstrual hygiene practices, including the use of sanitary products and appropriate methods of changing their pads.

The Importance Of HPV Vaccination

Reproductive health education must include HPV vaccination information, which would be the most effective way to prevent cervical cancer. HPV vaccination is something that many parents and young people don't know much about, including its benefits and recommended vaccination age. Therefore, educating people about how important it is to be vaccinated against HPV will help reduce the occurrence of cervical cancer in the future.

Encouraging Responsible Reproductive Health

The responsibilities regarding reproductive health also refer to the understanding of the process of puberty, but additionally include educating young people with regard to responsible behavior, respecting limits, practicing consent, and the importance of making informed decisions.

Building a Healthier Generation

Educating teenagers is very important in order to have a healthy generation in the future. Everybody should work together to create a supportive environment that encourages discussions regarding reproductive health problems. The promotion of awareness regarding PCOS, HPV vaccinations, and other reproductive health problems would also enable our children to become proactive in taking care of their health.

(Dr. Priya Gupta, Senior Consultant - Obstetrics and Gynecology, Cocoon Hospital, Jaipur)

Pregnancy is often considered to be a journey that begins with a positive pregnancy test. But medical experts agree that the foundation of a healthy pregnancy is laid much earlier, through preconception care, and strengthened throughout pregnancy with consistent antenatal care. The two stages together are important for the health and well-being of both mother and baby.

Preparing for Parenthood Before Conception (Preconception Care): Why it's important.

Preconception care is the care that happens before a woman becomes pregnant. It involves identifying and managing medical, nutritional and lifestyle factors that may affect pregnancy outcomes. If you’re planning a pregnancy or thinking about getting pregnant in the near future, it’s a good idea to prepare your body in advance to help lower the risk of complications. This is especially important considering that 40–50% of pregnancies worldwide are estimated to be unintended, according to the World Health Organization (WHO).

A preconception health check-up will usually include a review of your medical history, screening for chronic conditions such as diabetes, hypertension, thyroid disorders and anemia, assessment of your vaccination status and discussion of any medications that may not be safe during pregnancy. Doctors also advise women to start taking folic acid supplements at least a month before they conceive to help prevent neural tube defects in the developing baby.

And the healthy lifestyle choices are equally important. Maintaining an ideal weight, following a balanced diet, engaging in regular physical activity, avoiding tobacco and alcohol, and managing stress can improve fertility and contribute to a healthier pregnancy.

Every Check-Up Counts (Antenatal care)

Antenatal care should be routine once pregnancy is confirmed. These regular medical visits allow healthcare providers to monitor the growth and development of the baby and watch the mother’s physical and emotional health. WHO recommends at least 8 antenatal contacts. The guideline was increased from four visits to eight contacts during pregnancy to improve maternal and newborn outcomes and reduce preventable stillbirths.

Blood pressure, weight, blood and urine tests, ultrasound scans and fetal growth are regularly checked during routine antenatal appointments. These tests help to identify potential problems such as gestational diabetes, preeclampsia, anemia, or restrictions in fetal growth early on so that treatments can be given in a timely manner.

Antenatal care also gives valuable advice on nutrition, exercise, sleep, mental well-being, breastfeeding preparation and identifying warning signs that require immediate medical attention. Most importantly, it reassures expectant parents and helps to address concerns throughout pregnancy.

Pregnancy care is not just the expectant mother's responsibility. Partners and families can play an important role in providing a supportive environment, encouraging healthy habits, attending medical appointments when able, and providing emotional support. Having a supportive system can help to lower stress levels and improve maternal mental health, which can contribute to better pregnancy outcomes.

As awareness grows, health care providers are encouraging couples to think beyond the baby bump and prioritize health even before pregnancy begins. With advance planning, regular medical care, fact-based lifestyle choices and prompt treatment, when necessary, you can make a real difference and help ensure that pregnancy is a safer and healthier experience for mother and child.

(Dr. Roli Banthia, Consultant- Obstetrics and Gynaecology, Yatharth Super Speciality Hospital, Noida Extension)