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

Pennsylvania’s health department has issued a health alert on congenital measles for the first time in decades as cases rise among pregnant women and newborns.

As of October 19, Pennsylvania had reported 1,286 measles cases across 42 counties, with 247 hospitalizations and six reported deaths. At least 50 pregnant women have reportedly been affected.

At least one death has been linked to congenital measles. The first death reported in the current outbreak was that of a newborn boy who died immediately after birth while his mother was severely ill with measles.

The health department said the outbreak had raised concerns about congenital measles, which has not been identified in the state for decades. The alert provides clinical guidance on managing measles during pregnancy and in newborns.

Decades of MMR vaccination meant many doctors had never encountered such cases. However, declining vaccination rates have allowed measles to spread in under-vaccinated communities.

Nationwide, 4,410 confirmed measles cases had been reported as of October 15, according to the US Centers for Disease Control and Prevention (CDC). Of these, 96% were in unvaccinated people.

Also read: What Happens After Measles Infection? The Hidden Risks That Can Last For Years

What Is Congenital Measles?

Congenital measles occurs when a pregnant woman contracts measles and transmits the virus to her fetus through the placenta.

According to the American College of Obstetricians and Gynecologists (ACOG), newborns with clinical or laboratory evidence of measles within the first 10 days of life following exposure in the womb are considered to have congenital measles.

Historical reports suggest that transmission occurs in approximately 25% to 30% of cases when the mother develops measles in the days before delivery, although data are limited.

What Happens to Babies With Congenital Measles?

Congenital measles can range from an asymptomatic infection to severe disease and death, according to ACOG. Symptoms may include fever, rash and jaundice. Complications can include pneumonia, low platelet counts and neurological problems. The rash may appear late, look different or be absent.

Can Congenital Measles Be Fatal? What To Watch For In Newborns?

Read More: Measles Cases Are Rising in US—Who Should Get A Booster Shot?

Before immune globulin became widely used, congenital measles mortality was reported to be as high as 30%.

Affected newborns also face an increased risk of subacute sclerosing panencephalitis (SSPE), a rare, fatal brain disease that can develop months to years after infection.

ACOG advises considering newborns at risk of symptomatic, transmissible measles if they are born after maternal symptoms begin and up to 14 days after the mother's rash onset.

Asymptomatic newborns who initially test negative may be considered for repeat testing on day 10 of life to check for infection acquired in the womb.

How Can Parents Protect Their Babies From Measles?

MMR vaccination before pregnancy is the best way to prevent measles during pregnancy and reduce the risk of congenital measles.

Women without evidence of immunity should receive at least one MMR dose in non-outbreak settings and two doses at least 28 days apart during outbreaks.

Because MMR is a live vaccine, it should not be given during pregnancy. Women should avoid pregnancy for 28 days after vaccination.

Pregnant women who may have been exposed to measles or are unsure of their immunity should promptly contact their healthcare provider.

The pertussis vaccine, which protects against whooping cough (Bordetella pertussis), a highly contagious bacterial respiratory infection, offers strong protection in young children, according to a new study led by the US Centers for Disease Control and Prevention (CDC).

Published in the CDC’s Morbidity and Mortality Weekly Report (MMWR), the study found that children who received three or more doses of the diphtheria, tetanus, and acellular pertussis (DTaP) vaccine had 96.2% protection against laboratory-confirmed pertussis.

Pertussis Vaccine Offers Strong Protection

The DTaP vaccine is administered in a five-dose childhood series. The first dose is given at 2 months of age, followed by doses during infancy and early childhood. The final dose is recommended between ages 4 and 6 years.

The MMWR study compared children in Alaska who had received three or more DTaP doses with those who were unvaccinated or had received fewer doses than recommended.

Unvaccinated children had approximately 26 times the odds of developing laboratory-confirmed whooping cough compared with vaccinated children.

Overall, adjusted vaccine effectiveness against pertussis was 96.2% among children who had received three or more DTaP doses. Partial vaccination also offered protection, with effectiveness reaching 85.3% among children who had received one or two doses.

“Pertussis vaccination is effective in preventing laboratory-confirmed pertussis in young children,” said corresponding author Joseph McLaughlin of the Section of Epidemiology, Alaska Department of Health, Anchorage.

Also read: RSV Warning: Welsh Mum Urges Pregnant Women To Get Vaccine After Baby Nearly Dies

Whooping Cough Can Cause Severe Complications

Pertussis can cause serious complications in young children, including pneumonia, pauses in breathing (apnea), seizures, brain damage, and death. Severe coughing fits can also trigger vomiting and, in some cases, fractured ribs.

Infants younger than 6 months are particularly vulnerable because their immune systems are still developing. Babies may not develop the characteristic “whoop” sound and can instead experience feeding difficulties or pauses in breathing, making the infection harder to recognize.

According to a provisional CDC report, 16 people died from pertussis in the United States in 2025, including 10 infants.

Whooping cough spreads through respiratory droplets and can affect people of any age. However, newborns and people who are not adequately vaccinated face a greater risk of severe illness.

Previous research has also found that unvaccinated children are more likely to develop severe illness or require hospitalization than vaccinated children.

Childhood Vaccination Rates Have Declined In The US

Read More: US Kindergarten Vaccination Rates Decline, Exemptions Rise as Measles Cases Hit 35-Year High

Despite the protection offered by vaccination, DTaP coverage among US kindergartners has declined in recent years.

CDC data show that coverage fell to 92% in the 2025–26 school year, down from 95.2% in 2017–18.

The findings underscore the importance of maintaining high childhood vaccination coverage to reduce pertussis infections and protect children against severe illness and death.

Identifying Whooping Cough Symptoms

Whooping cough often begins with cold-like symptoms, including a runny nose, sneezing, a mild cough, and sometimes a low-grade fever. After one to two weeks, coughing fits may become more severe and persistent.

The cough can be followed by a characteristic whooping sound as the person gasps for air. Vomiting after coughing fits can also occur. However, symptoms vary, particularly in infants, who may experience breathing difficulties without a typical cough.

Diagnosis may involve laboratory testing of a nasal or throat sample. Early recognition is especially important in infants because the infection can progress to serious complications.

Herpes simplex virus (HSV), which commonly causes cold sores, usually causes mild symptoms in adults but can be life-threatening in newborns, whose immune systems are still developing.

Meg Edmonds, from Staffordshire, UK, lost her 10-day-old daughter, Magnolia, to HSV in February.

“We didn't know a cold sore could kill a baby,” Meg told the BBC. She is now urging parents to learn about the risks cold sores pose to newborns.

The virus is suspected to have been passed on to Magnolia by her mother.

“The guilt is obviously unbearable; it's horrific, but I just try and remind myself that I didn't know and I did what I could have done with the knowledge that I did have,” Meg said.

Mother Did Not Know Cold Sores Could Endanger Newborns

Also read: Rare Pregnancy Infections Linked To 3-Fold Higher Autism Risk: What Is TORCH?

The 22-year-old said Magnolia was born “perfectly healthy” after what she described as a straightforward “water birth”.

Only later did Meg realise she had a sore on her lip around the time of the birth.

“Looking back at photos now, I can see that I had a lesion or sore on my lip whilst I was giving birth which I thought nothing of at the time,” she said.

Meg, who had never experienced a cold sore before, sought advice from health professionals but was reassured that the sore was nothing to worry about.

“They just thought that I might need to drink more or that it might just have been hormonal from giving birth only the day prior, so I thought nothing of it,” she said.

Magnolia's condition later deteriorated, and she died from HSV, according to the report.

Cold Sore Outbreak Brings Back Painful Memories

Meg said she had avoided visitors who were unwell, never kissed Magnolia and washed her hands frequently to protect her newborn from infections.

“I washed my hands constantly because I was worried in general about infections. But I never knew that if that passed to her it could kill her,” she said.

A subsequent cold sore outbreak brought back painful memories.

“I'm constantly reminded anyway that my daughter isn't here any more and why that is, but to actually have a physical reminder on my face is horrible,” she said.

How To Protect Newborns From HSV

Read More: Baby Not Sitting by 9 Months? Warning Signs Parents Should Know

According to the UK's National Health Service (NHS), newborns are particularly vulnerable to HSV, especially during the first six weeks of life. The infection can affect the eyes, mouth and skin or spread to other organs, potentially becoming life-threatening.

HSV can spread after birth through contact with a cold sore, including when someone with an active cold sore kisses a baby. It can also spread through herpes blisters on the breast during breastfeeding.

The NHS recommends these precautions to reduce the risk of infection:

• Wash hands: Wash hands thoroughly before handling a newborn.
• Avoid kissing: People with an active cold sore should not kiss a baby.
• Prevent direct contact: Keep cold sores and other herpes lesions away from the baby.
• Take care during breastfeeding: Do not breastfeed from a breast with herpes blisters until they have healed. Seek medical advice about feeding and expressed milk from the affected breast.
• Inform healthcare professionals: Pregnant women with a history of genital herpes or symptoms of a possible infection should inform their doctor or midwife.

Warning Signs Of Neonatal Herpes

Babies may not develop visible blisters, and neonatal herpes can progress rapidly. Seek urgent medical attention if a newborn has:

• Unusual irritability or difficulty settling.
• Poor feeding or feeds less than usual.
• A fever of 38°C or higher.
• A rash or sores on the skin, eyes or inside the mouth.
• Unusual lethargy, floppiness or difficulty waking.
• Breathing difficulties or seizures.