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

Winter may feel refreshing for adults, but for newborns, it is one of the most vulnerable seasons of the year. Infants have immature immunity and cannot regulate their body temperature efficiently, making them prone to cold stress, infections, and breathing difficulties. In a conversation with Health and Me, Dr. Manju Kumari shared essential guidance for parents navigating their baby’s first winter.

Keeping Your Baby Warm

Newborns lose heat rapidly, and even a slight drop in temperature can lead to distress. Dr. Kumari explains that “infants cannot regulate their body temperature effectively, which is why small measures go a long way.”

She advises dressing babies in soft, light layers rather than one thick piece of clothing, as layering traps warmth better and prevents overheating. The head and feet should always be covered with a cap and socks since “heat loss is maximum from these areas.”

Parents must ensure the room is comfortably warm, especially during sleep time. However, loose blankets should never be placed over a baby’s face or neck. “This increases the risk of SIDS,” she notes. Bathing should also be brief—no more than 2–3 minutes, with warm (not hot) water and away from fans or cold drafts.

Preventing Infections During Winter

With colder weather comes a spike in viral infections, making newborns particularly vulnerable. “Their immunity is still developing, so simple precautions matter,” Dr. Kumari says.

Parents should:

• Limit visitors during the first weeks
• Wash hands before touching the baby
• Avoid anyone who shows symptoms of a cold or flu
• Keep the room ventilated to reduce indoor pollution
• Maintain a clean environment for feeding and sleeping
• Stay updated with vaccinations and follow pediatric advice

According to her, infection control begins at home, and these small actions significantly reduce a baby’s exposure to harmful germs.

Caring for Skin and Breathing

Winter dryness and pollution can irritate a baby’s delicate skin and airways. Dr. Kumari recommends using gentle, fragrance-free moisturizers and avoiding strong soaps.

Blocked noses are common, and she advises saline nasal drops only under a paediatrician’s guidance. She emphasizes keeping infants away from incense sticks, scented sprays, smoke from cooking, and heater fumes. “Their lungs are extremely sensitive. Clean air around a newborn is non-negotiable,” she says.

A dust-free, odor-free sleeping area is crucial for easy breathing and quality rest.

Warning Signs Parents Should Never Ignore

Recognizing distress early can prevent complications. Dr. Kumari lists key red flags:

• Fast or labored breathing
• Feeding poorly or refusing feeds
• Fever or unusually low temperature
• Sudden lethargy
• Pale or bluish skin

“If any of these signs appear, seek immediate medical attention,” she stresses. Early intervention can make all the difference in a newborn’s outcome.

Small Steps, Big Difference

Winter care, Dr. Kumari assures, “is not as complicated as it seems.” Thoughtful adjustments, appropriate clothing, safe sleeping practices, good hygiene, and close monitoring, can protect babies from most seasonal risks.

“With a warm, clean, and safe environment, parents can ensure their newborns thrive even in the cold months,” she concludes. These simple habits not only safeguard health but also make the early months more joyful and stress-free for new families.

Every year on November 17, World Prematurity Day is observed, and this year, the global theme was 'Give preterm babies a strong start for a bright future'. The day is observed to raise awareness around premature birth, emphasize the importance of quality care, and advocate for better health outcomes for preterm infants and their families.

To understand how can one take better care of preterm babies, Health and Me spoke to Dr Sanjay Wazir, Medical Director, Neonatology and Pediatrics at Motherhood Hospitals, Gurugram.

Dr Wazir points out that at first the Neonatal Intensive Care Unit or the NICU may seem overwhelming, however, it must be seen as a sanctuary of healing. "In the NICU, premature or unwell newborns receive specialized medical attention, constant monitoring, and compassionate care from expert hands. Here, the mother and the baby are well taken care of. This will help the baby lead a healthy life. Hence, NICU care is important for all the premature or unwell babies," he says.

What The Parents Go Through?

Doctor rightly points out that for any parent seeing their babies in NICU could be frightening, especially seeing their child surrounded by wires, machines, or even incubator could trigger worry and confusion. However, he says that new parents should not fret or panic. He says that NICU is a place designed to give fragile newborns the best possible start in life. "Here, premature babies, those with low birth weight, or those needing medical support after delivery receive round-the-clock care from a dedicated team of neonatologists and nurses," he explains.

What Happens Inside The NICU?

The doctor explains that the NICU provides a controlled and nurturing environment where babies can grow stronger outside the womb. "It helps maintain their body temperature, supports breathing, and ensures proper nutrition through feeding tubes if necessary," he says.

Every machine in the NICU is for a specific purpose, right from oxygen support to heart rate monitoring, ensuring that each baby receives precisely what they need. Parents often find comfort knowing that the experts in the NICU are constantly watching over their child’s progress, explains the doctor.

The doctor points out that parents are essential part of the NICU journey. "Your touch, your voice, and your calm presence can help your baby feel safe and comforted," he tells to all the parents. However, what is extremely important is to maintain hygiene guidelines, staying involved in daily care, and communicating regularly with the doctors and nurses to "strengthen your bond and confidence as caregivers." The doctor says that during this time, the mother will also be taught about Kangaroo care, which is skin-to-skin contact that helps the mother bond with her baby.

Journey To Home

"Each beep and monitor in the NICU tells a story of progress. Some days may be tough, but the baby will be able to thrive after prompt attention," notes the doctor. While the experience can be emotional, parents must remember that the journey is also filled with hope. With expert care and a parent’s love, many premature and unwell babies go on to lead healthy, happy lives.

Many women who are planning to start a family, the words “low AMH” can instantly trigger fear or confusion. AMH, or Anti-Müllerian Hormone, is commonly used as an indicator of ovarian reserve. This is the approximate number of eggs remaining in a woman’s ovaries. However, experts stress that a low AMH value does not mean pregnancy is impossible. With early diagnosis, the right treatment, and supportive lifestyle changes, women with low AMH can and do conceive successfully.

What Low AMH Actually Means

AMH levels naturally decline with age, especially after 30. According to Dr Varsha Agarwal, Consultant, Fertility & IVF Specialist at Motherhood Fertility & IVF, Noida, a low AMH value simply suggests that the number of available eggs may be lower than average. It does not assess the quality of the eggs, nor does it predict whether a woman can or cannot become pregnant.

Dr Agarwal explains that many women misunderstand AMH and assume that a low value is a final verdict on fertility. In reality, women with low AMH can still produce healthy eggs and can conceive either naturally or with medical assistance. “There is a lack of awareness when it comes to AMH,” she notes, adding that it is crucial not to rely on social media posts or forwarded messages that often fuel myths around fertility.

The key is early awareness, timely medical guidance, and personalized counselling so women can make informed choices about their reproductive health.

Treatment Options and Advanced Medical Support

Fertility treatments have become far more sophisticated and personalized today. Depending on age, AMH levels, and overall reproductive health, doctors may recommend approaches such as:

• Ovulation stimulation to support natural conception
• IVF (In Vitro Fertilization) for better egg retrieval and fertilization
• Egg freezing for women planning pregnancy later in life

Dr Agarwal emphasizes that many women with low AMH respond positively to these treatments. With careful monitoring, tailored protocols, and expert intervention, the chances of conception remain promising.

Alongside medical treatment, lifestyle also plays a crucial role. Maintaining a healthy weight, eating balanced meals, reducing stress, ensuring adequate sleep, and avoiding smoking or alcohol can improve reproductive outcomes. These habits support hormonal balance and egg health, enhancing the effectiveness of any fertility plan.

Being Proactive Matters

One of the most important steps women can take is to avoid delaying fertility evaluations—especially if they plan to conceive later in life. Low AMH should be seen as a signal to take proactive measures, not a reason to panic.

Dr Agarwal encourages women to prioritize regular check-ups, consult specialists early, and stay informed about their bodies. “Women need to take charge of their fertility health,” she says. “With expert guidance and timely intervention, the journey to motherhood is still very much possible.”