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

A Welsh mother whose newborn daughter nearly died after contracting respiratory syncytial virus (RSV) is urging pregnant women to get vaccinated to protect their babies.

Jo Goldsmith said she was told to “prepare for the worst” after her daughter Phoebe contracted RSV just five days after birth, the BBC reported. Phoebe, now four, developed breathing difficulties and was admitted to a hospital’s high-dependency unit.

Goldsmith said the vaccine was not available when she was pregnant but that she “definitely would have had it.”

“I wouldn't want any family to go through what we went through,” she said.

RSV vaccinations for pregnant women were introduced in Wales in September 2024.

“She was five days old, she had quite a lot of congestion... and we noticed quite quickly that she seemed to be breathing very fast and was struggling,” Goldsmith said.

What Is RSV?

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Respiratory syncytial virus (RSV) is a common respiratory virus that typically causes cold-like symptoms. However, it can lead to serious illness, including bronchiolitis and pneumonia, particularly in infants, older adults and people with weakened immune systems.

Almost every child contracts RSV by the age of two. The virus can cause severe illness in infants, with up to three in every 100 infected infants requiring hospitalization.

Maternal vaccination with RSVpreF (Abrysvo) helps protect newborns against RSV during their first months of life. However, uptake has remained relatively low in the US and Europe since the vaccine was introduced in 2023, according to a study published last week in The Lancet Regional Health – Europe.

In the UK, the RSV vaccine is routinely offered to pregnant women from 28 weeks of pregnancy to help protect their babies. It is also offered to eligible older adults, including everyone aged 75 and over. Older adults generally need only one dose, while women are advised to receive the vaccine during every pregnancy.

Maternal RSV vaccination allows protective antibodies to pass from the mother to the baby before birth. More than 30 countries have introduced maternal RSV vaccination, either as a stand-alone intervention or alongside other preventive measures, such as infant immunization.

How Does RSV Spread?

RSV spreads through respiratory secretions, including saliva and mucus, and through contact with contaminated surfaces. In the US, infections typically occur from late fall to early spring, although seasonal patterns vary by region.

What Are The Symptoms Of RSV?

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RSV symptoms usually appear four to six days after exposure. Early signs often resemble a common cold and include:

• Runny nose and sneezing
• Cough
• Decreased appetite
• Irritability and tiredness in infants

Babies may also develop rapid or labored breathing. In some cases, the infection spreads to the lower respiratory tract, causing bronchiolitis or pneumonia.

Parents should seek urgent medical attention if a baby has difficulty breathing, shows signs of dehydration or becomes unusually unresponsive. Severe breathing difficulties require emergency care.

Women with hypertensive disorders in pregnancy face a higher risk of death, while their babies are also at risk of serious illness and mortality, according to the World Health Organization (WHO).

Hypertensive disorders in pregnancy, which include pre-eclampsia and eclampsia, affect millions of women every year and complicate an estimated 10–15% of pregnancies worldwide. They account for around 16% of maternal deaths globally, resulting in an estimated 42,000 deaths each year, as well as more than 500,000 stillbirths and newborn deaths.

“Pre-eclampsia can develop in any pregnancy. Whether it becomes fatal depends on whether a woman's blood pressure was checked in time, and whether quality emergency care was within reach when it turned severe,” said Dr Pascale Allotey, Director of WHO’s Department of Maternal, Child, Adolescent Health.

WHO Launches Global Roadmap

Also read: 16 Million Indians Die Due To Hypertension Every Year: AIIMS Doc

To tackle hypertensive disorders of pregnancy, WHO today launched a new global roadmap at the Society for Maternal-Fetal Medicine Global Conference.

The roadmap brings together research, medicines, clinical guidance, health systems and political action so that a woman’s chances of surviving pregnancy and having a baby do not depend on where she lives.

It highlights a gap between the scale of the problem and the lack of medicines specifically developed and approved by regulators to prevent or treat pre-eclampsia or eclampsia.

Research investment has largely focused on diagnostics, with chronic underinvestment in new preventive and treatment options.

The roadmap also addresses gaps in blood pressure checks, medicines and emergency care. In many countries, women still lack reliable access to basic blood-pressure measurement, urine protein testing and essential medicines, including aspirin, antihypertensives and magnesium sulfate.

Weak referral systems, shortages of trained health workers and limited emergency obstetric services can further delay life-saving care.

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Women In Poorer Countries Face Higher Risks

In low- and middle-income countries, gaps in antenatal care, medicines, diagnostics, trained health workers and emergency services mean women are more likely to develop severe complications or die.

Women affected by poverty, humanitarian crises, geographic isolation and other challenges face particularly high risks.

How Pregnancy Hypertension Affects Mothers And Babies

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Hypertensive disorders in pregnancy include:

• Chronic Hypertension: High blood pressure before pregnancy or before 20 weeks.
• Gestational Hypertension: New high blood pressure after 20 weeks without protein in urine.
• Preeclampsia-Eclampsia: High blood pressure after 20 weeks with protein in urine or organ damage; eclampsia involves seizures.
• Superimposed Preeclampsia: Preeclampsia developing in a woman with chronic hypertension.

Pre-eclampsia and eclampsia are major causes of maternal death and severe illness worldwide. They contribute to stillbirth, preterm birth, newborn mortality and morbidity, and health-system costs.

Pre-eclampsia can also have consequences for mothers long after childbirth. Women affected by hypertensive disorders of pregnancy face increased risks later in life of chronic hypertension, cardiovascular disease, stroke and kidney disease.

Children exposed during pregnancy can face increased risks associated with preterm birth and longer-term cardiovascular and metabolic disease.

WHO Calls For Coordinated Action

WHO is asking governments, funders, researchers, health professionals, industry, civil society and development partners to align investment and action around one goal: ensuring that proven interventions and future innovations reach the women and babies who need them most.

The WHO roadmap sets a shared vision and coordinated actions across five areas: research and innovation; norms and standards; access to health products; implementation; and advocacy and accountability.

It aims to accelerate progress towards ending preventable maternal and newborn mortality and morbidity and stillbirth associated with hypertensive disorders, while contributing to SDG targets 3.1 and 3.2.

The effects childhood obesity could extend into adulthood. Similarly, a person's fitness level as a kid could have a significant impact on their wellbeing, especially mental health. New research suggests there may be a link.

A study led by researchers at the University of Tasmania’s Menzies Institute for Medical Research found that children and adolescents with better cardiorespiratory fitness were less likely to develop depression as adults. The findings, published in the Journal of Affective Disorders, are based on more than 30 years of follow-up.

Study Conducted Over A Span Of 30 Years

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Researchers studied data from the Childhood Determinants of Adult Health Study, which began in 1985. More than 1,000 Australian participants were assessed when they were between 7 and 15 years old and followed into adulthood, when they were aged 36 to 49.

Childhood fitness was assessed using physical tests including a 1.6-kilometre run, which measured cardiorespiratory fitness, and a standing long jump to assess muscular power.

A smaller group also underwent tests of muscular strength and fitness using a cycle ergometer. More than three decades later, participants completed a World Health Organization diagnostic interview to assess depression.

The strongest and most consistent association was between cardiorespiratory fitness and lower risk of depression later in life. The relationship appeared stronger among females, while the links involving muscular fitness were less consistent.

Dr Brooklyn Fraser, a researcher at the Menzies Institute, said the study offered a rare opportunity to examine the relationship across such a long period.

“The data collected over 30 years has given us a rare opportunity to examine how early-life fitness relates to mental health later in life,” Fraser said. “We found that children and adolescents with better cardiorespiratory fitness had a lower risk of developing depression as adults.”

Fitness In Childhood Linked To Mental Health Decades Late

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The study does not establish exactly why childhood fitness was associated with better mental health later in life. But one possibility is that cardiorespiratory fitness reflects a combination of physical activity, cardiovascular health and other behaviours that can influence mental wellbeing. Staying active during childhood may also contribute to healthier habits that persist into adulthood.

Exercise itself has been linked with several aspects of better mental health, including mood, sleep and stress regulation. Social interaction through sports and physical activity could also play a role. But researchers caution against reducing depression to a single lifestyle factor.

“There are many contributing factors to depression, meaning no single factor explains risk on its own. Fitness may be one piece of the puzzle,” said Dr Kylie Smith, the study’s lead author.

The researchers measured fitness at one point in childhood and then examined depression decades later. Factors throughout those intervening years, including genetics, social circumstances, physical health, stress, lifestyle and other experiences, can all influence depression risk.

“While we cannot say a lack of fitness during childhood causes depression in adults, the findings suggest that childhood fitness may have benefits beyond physical health,” Smith said.

A 2026 review and meta-analysis involving more than 4 million people found that higher cardiorespiratory fitness was associated with a lower risk of depression in adults.

The study adds to evidence supporting opportunities for children to move regularly, play outdoors, participate in sports they enjoy and build fitness. Professor Grant Tomkinson of Adelaide University said fitness is important because it is something that can be changed.

“We already know that being physically active is good for our mental health, and previous research has shown that fitter adults are less likely to develop depression,” Tomkinson said. “But we know relatively little about whether being fit early in life is linked to better mental health decades later.”