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

As per the American Psychological Association (APA), only 58.5 per cent of US teens always or usually receive the social and emotional support they need, as per the report by the US Centers for Disease Control and Prevention (CDC).

Another National Institutes of Health (NIH, US) report notes that the most mental health disorders among children ages 3 to 17 in 2016 to 2019 were attention deficit disorder (9.8%, approximately 6 million), anxiety (9.4%, approximately 5.8 million), behavior problems (8.9%, approximately 5.5 million), and depression (4.4%, approximately 2.7 million). For adolescents, depression is concerning because 15.1% of adolescents ages 12-17 years had a major depressive episode in 2018-201.

However, not all are able to receive the help, in fact, parents too find themselves struggling when it comes to helping their children.

Despite growing concern about a mental health crisis among young people in the United States, a large national study suggests the care system continues to fall short for many families.

Researchers from the Harvard Pilgrim Health Care Institute in Boston found that nearly one quarter of children who require mental health treatment are not receiving it.

The findings come from survey data collected from more than 173,000 households between June 2023 and September 2024.

Many Families Recognize the Need but Cannot Get Help

The analysis showed that about one in five households, or 20 per cent, had at least one child who needed mental health support. Yet among those families, nearly 25 per cent said those needs were not met.

Even families that eventually obtained care often faced significant hurdles. Nearly 17 per cent described the process as difficult and exhausting.

The research letter was published February 16 in JAMA Pediatrics.

Household Structure Shapes Access

The study found that family circumstances strongly influenced how easy it was to navigate the health care system.

Families with multiple children reported higher unmet needs at 28 per cent, compared with 21 per cent in households with only one child. Single parent households also reported more difficulty securing appointments.

Education setting played a role as well. Homeschooled children had higher unmet needs at 31 per cent compared with 25 per cent among children attending public school. Researchers suggest this may reflect the absence of school counselors and other school based support systems.

Insurance and finances created additional barriers. About 40 per cent of families covered by Medicaid or without insurance said they could not get care specifically because it was too hard to access.

In a news release, lead author Alyssa Burnett said nearly one quarter of parents reported that at least one child did not receive needed mental health care, highlighting persistent access gaps.

Cost, Availability and Logistics Remain Major Obstacles

Researchers noted several common barriers. Families cited treatment costs, a shortage of clinicians and logistical issues such as scheduling and travel.

The study also found disparities among racial and ethnic groups. Families from minority backgrounds had higher rates of unmet needs compared with non Hispanic white households. However, Black households reported less difficulty accessing care at 13 per cent compared with 17 per cent among white households.

Bringing Care Closer to Families

Experts involved in the study say improving access may require shifting where care is delivered.

Senior author Hao Yu, an associate professor of population medicine at the institute, said states should expand the child mental health workforce and integrate mental health services into primary care settings to remove barriers and improve access to needed treatment.

A majority of women may experience infections during the crucial phase of pregnancy. Some infections during pregnancy may also not show clear symptoms. However, timely awareness and prevention can protect both the mother and the baby.

Pregnancy is a special and sensitive phase in a woman’s life. While most women focus on nutrition and regular check-ups, infections during pregnancy can often be neglected.

Some infections may cause only mild symptoms in the mother but can seriously affect the unborn baby if not detected early. Hence, regular screening, good hygiene, and timely medical care are crucial to prevent most pregnancy-related infections and ensure a safe and healthy pregnancy.

Common Infections During Pregnancy

• Urinary Tract Infections (UTIs)

• Vaginal infections

• Respiratory infections

• TORCH infections

• Hepatitis B and C can be passed from mother to baby during childbirth if not properly managed.

Tips To Follow To Prevent Infections During Pregnancy

• Pregnant women should go for regular antenatal check-ups, maintain good personal hygiene, and not use any chemical-laden products.
• Stay hydrated and drink enough water, eat home-cooked food, avoid raw or undercooked items, wash your hands frequently, and get vaccinated as recommended by the doctor.
• Take a flu shot on a priority basis. Avoid contact with rodents and pets.
• Make sure to consult the expert in case of symptoms such as fever, pain, or unusual discharge for prompt intervention.
• Get tested for sexually transmitted diseases (STDs) such as HPV, chlamydia, gonorrhea, herpes, syphilis, and trichomoniasis.
• Early detection and treatment will be beneficial in safeguarding both mother and baby and ensuring a healthy pregnancy.

Motherhood is not easy to navigate from, while there are many telling you what to do after becoming a parent, rarely do mothers get the guidance they need, especially about disease transmission. Some infections in mothers can pass on to babies during pregnancy, delivery or even while breastfeeding. Know which ones are they:

HIV

It is human immunodeficiency virus that attacks cells that help the body fight infections and makes the person vulnerable to diseases. The virus can be transmitted through contact with infected blood, semen or vaginal fluids.

HIV can be transferred to the baby during birth or even while breast feeding, notes the Centers for Disease Control and Prevention (CDC). The risk of transmission is highest in the early months of breastfeeding and the rate is estimated to be at least 16%, and prolonged breastfeeding nearly doubles the chances.

Hepatitis B

Also known as HBV is a viral infection that, as per the World Health Organization (WHO) causes live infection and can lead to short term or chronic disease. It can be spread by exposure to infected bodily fluids.

It can be passed on to the child at birth, however to prevent this, the babies can receive the HBIG/HBV vaccines at birth. CDC also mentions that the risk of HBV mother-to-child transmission through breastfeeding is negligible if the vaccine is received.

Syphilis

As per WHO, it is a preventable and curable bacterial sexually transmitted infection that can cause serious health issues if it is left untreated. Many people with syphilis do not have any symptoms, or do not notice them. It can be transmitted during oral, vaginal, and anal sex, in pregnancy and through blood transfusion.

Cytomegalovirus (CMV)

CDC notes that this is the most common infectious cause of birth effects in the United States and can spread through body fluids like saliva and urine. It is a genus of viruses in the order Herpesvirales, in the family of Herpesviridae.

Zika Virus

As per WHO, Zika virus infection during pregnancy can cause infants to be born with microcephaly and other congenital malformations as well as preterm birth and miscarriage.

It is a mosquito-borne virus that can cause serious birth defects, notes the CDC.

Toxoplasmosis

Toxoplasmosis is an infection with a parasite called Toxoplasma gondii, which can be found in uncooked meat. This can also be contacted by cat feces and the parasite can be passed down to a baby during pregnancy.