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

Pediatric hematological malignancies, specifically leukemia and lymphoma, constitute some of the most frequently observed forms of cancer in pediatrics.

Pediatric cancers make up almost 7.9% of all cancers that are diagnosed in India, according to figures released by the Indian Council of Medical Research (ICMR).

Leukemia is responsible for almost half of all pediatric cancers in children under 14 years old.

Why Early Detection Matters: Common Symptoms

Healthcare professionals assert that early detection is essential in enhancing treatment success. Nevertheless, the symptoms are often mild and can be easily misdiagnosed as other childhood conditions.

Parents need to carefully observe any symptoms such as recurring fever, fatigue, susceptibility to infections, inexplicable bruising, and gum and nose bleeds. Pain in bones and joints, swelling in the lymph nodes, rapid weight loss, pale complexion, and protracted weakness are some other red flags that must not be overlooked.

Parents usually think these symptoms are associated with infections during the changing season or lack of nutrients in the body; however, if such symptoms do not subside within two weeks, medical attention is vital.

How Blood Cancer Affects The Body

The origins of blood cancer are found in bone marrow, causing problems with blood cell development. Symptoms can include anemia, which causes a low hemoglobin level, as well as low platelet levels and immune problems.

According to experts, a child suffering from blood cancer may also experience symptoms like fatigue and poor appetite.

Awareness Can Save Lives

Fortunately, good progress has been made in terms of survival rates for pediatric blood cancers through early diagnosis and new treatment techniques.

Research and professional opinions indicate that a significant number of kids who suffer from ALL, which is the most prevalent type of blood cancer among children, are able to enter long-lasting remission.

The importance of awareness among parents cannot be understated. Not every fever and bruise indicates cancer; however, symptoms that are seen are inexplicable and must always be taken into consideration. It is critical to consult an expert on time; this will definitely make a difference in treatment and recovery.

Many people carry the thalassemia gene without knowing it because they may not have any symptoms. A simple carrier screening test before pregnancy can help couples understand risks and make informed decisions while planning parenthood.

Importance of Genetic Screening

Parenthood planning today is not only about financial preparation or healthy lifestyle changes, but also about understanding genetic health risks that can impact the child’s future. And one such condition that tends to go unnoticed is thalassemia carrier status.

Did you know? Many individuals discover they are carriers only after facing difficulties during pregnancy or after the birth of a child with thalassemia major.

What Is Thalassemia?

Thalassemia is an inherited blood disorder that affects the production of hemoglobin, the protein in red blood cells that carries oxygen throughout the body. People who are carriers usually live normal and healthy lives and may not experience major symptoms. Because of this, many remain unaware of their carrier status for years.

However, it becomes a matter of concern when both partners are carriers of the thalassemia gene. In such cases, there is a huge risk that the child may inherit thalassemia major, a severe condition that may require lifelong blood transfusions, regular hospital visits, medications, and continuous medical care.

Why Thalassemia Often Goes Undetected

These are some of the challenges faced by families: So, challenges are that the thalassemia carrier status is often detected very late. Mild tiredness or anemia may be ignored or mistaken for iron deficiency, and many will not seek help.

So, couples do not consider genetic testing before marriage or pregnancy because they feel healthy and have no family history of the disease. When a child is born with thalassemia major, families may face stress, anxiety, repeated hospital visits, financial burden, and long-term treatment responsibilities. The condition can also affect the child’s growth, immunity, and overall quality of life.

The Need For Awareness And Early Action

This is why screening is important for couples: Carrier screening is a simple blood test that helps identify whether a person carries the thalassemia gene. If one partner tests positive, the other partner is advised to get tested as well.

Early screening before pregnancy helps couples understand their risks and explore available options with proper guidance. Thalassemia carrier screening is a small step that can make a major difference in parenthood planning.

Increasing awareness and encouraging timely testing can help families make informed decisions and reduce the burden of severe thalassemia in future generations. So, it is imperative to go for timely screening as advised by the expert and improve the quality of life.

Preeclampsia is usually discussed as a pregnancy complication, but the risk does not end automatically after childbirth. Delivery is an important part of treatment, but it is not an instant cure. A woman can still develop postpartum preeclampsia in the days or weeks after delivery, even if her blood pressure was normal during pregnancy.

The risk is highest soon after childbirth, but it can remain for up to six weeks. This period needs close attention because the mother is recovering, sleep-deprived, caring for a newborn, and may mistake warning signs for normal post-delivery discomfort. This is when the condition can become dangerous if symptoms are missed.

The warning signs of postpartum preeclampsia should be taken seriously. A severe headache, blurred vision, seeing spots, swelling of the face or hands, pain below the ribs, nausea, vomiting, breathlessness, chest pain, reduced urination, sudden weight gain, or very high blood pressure should be checked urgently.

If postpartum preeclampsia is not treated in time, it can lead to seizures, known as eclampsia, and may also cause stroke, fluid in the lungs, acute liver or kidney injury, and, in rare severe cases, hepatic subcapsular hematoma, which is bleeding beneath the capsule of the liver, or intracranial bleeding, also called brain hemorrhage. In the most severe cases, it can be fatal.

The reassuring part is that the condition is treatable when identified early. Treatment may include blood pressure medicines such as labetalol, nifedipine, or amlodipine, magnesium sulphate if there is a risk of seizures, and diuretics in selected cases where there is fluid overload. Many of these decisions can be safely planned even if the mother is breastfeeding, but treatment should always be guided by her treating doctor.

The responsibility should not fall only on the mother. Families need to watch her health with the same seriousness with which they attend to the newborn. As a precaution, blood pressure checks should continue at home or during scheduled visits, especially in the first few weeks after delivery. Postpartum follow-ups should not be missed, prescribed medicines should be taken properly, and self-medication should be avoided, particularly painkillers or over-the-counter drugs unless approved by the doctor. If symptoms worsen, or if there is headache, breathlessness, chest pain, visual disturbance, or swelling, she should be taken back to the hospital without delay.

A history of preeclampsia also remains important after recovery because it can increase the woman’s future risk of chronic hypertension, heart disease, stroke, and kidney disease. Postpartum care should never be treated as a formality. It is an essential part of protecting the mother’s recovery, her future pregnancies, and her long-term health.