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

Rare infections transmitted from a pregnant woman to her baby may be linked to a higher risk of autism and intellectual disability, according to a large new study.

Researchers at the Karolinska Institutet in Sweden found that children with congenital TORCH infections had about three times the risk of autism compared with children without these infections.

What Is TORCH?

TORCH refers to infections that can be transmitted from mother to foetus during pregnancy, including:

• T = Toxoplasma
• O = Other (including infections such as syphilis):
• R = Rubella
• C = Cytomegalovirus (CMV)
• H = Herpes simplex virus

These infections can cross the placenta and infect the developing fetus.

“It is important to emphasize that it is unusual for these infections to be transmitted from mother to child. They account for a very small proportion of all cases of autism in the population, but for those children who are actually affected, we see a clearly elevated risk of both autism and intellectual disability,” said Reneé Gardner, a researcher at the Department of Global Public Health at Karolinska Institutet.

Also read: Stem Cell Therapy For Autism: What India’s New Advisory Means For Patients

TORCH Infections And Autism Risk

Published in JAMA Pediatrics, the study analysed data from 3.7 million people born in Sweden between 1987 and 2021. Of these, 975 had a diagnosed congenital TORCH infection. The participants were followed for up to three decades.

Compared with children without a congenital TORCH infection, those with one were:

• About three times more likely to be diagnosed with autism
• More than seven times more likely to have an intellectual disability
• Up to 30 times more likely to have severe to profound intellectual disability

What Did The Sibling Comparison Show?

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The researchers also compared children with TORCH infections with their unaffected siblings to assess whether shared family factors could explain the findings.

The results were similar, suggesting that the associations were not explained solely by factors shared within families.

No clear association was found between TORCH infections and ADHD or obsessive-compulsive disorder. However, children with the infections had poorer academic performance on average, even when they did not have an autism or intellectual disability diagnosis.

Can TORCH Infections Be Prevented?

“Although these congenital infections are rare, some of them can be prevented, which makes them important from a public health perspective,” Gardner said.

The researchers also noted that rubella has virtually disappeared in Sweden following the introduction of national vaccination program. The prevention also depends on the infection:

• Toxoplasmosis: Avoid raw or undercooked meat, wash produce and take precautions when handling cat feces.
• Syphilis and other infections: Pregnancy screening and appropriate treatment can reduce transmission.
• Rubella: MMR vaccination before pregnancy can prevent infection.
• CMV: Good hand hygiene and avoiding contact with young children's saliva and urine can reduce exposure.
• Herpes simplex: Identifying and managing genital herpes during pregnancy can reduce the risk of transmission to the newborn. Caesarean delivery may be recommended in some cases when active lesions are present during labor.

We may now have a clearer explanation behind ‘mommy brain’ or ‘momnesia’. Walking into a room and forgetting why you went there or losing track of a conversation is not simply a side effect of becoming a mother.

A new study has discerned a possible explanation for the phenomenon commonly known as “momnesia,” “pregnancy brain” or “mommy brain”. The findings were published in Science Bulletin.

According to the study, persistent high levels of estrogen during pregnancy may disrupt a particular brain circuit involved in memory.

Researchers found that high estrogen affected communication between the hypothalamus and hippocampus, two brain regions involved in regulating different aspects of brain function, including memory.

What Is “Momnesia”?

Pregnancy-related forgetfulness is generally considered to be temporary changes in memory and cognition during pregnancy.

Researchers say forgetfulness can become noticeable in late pregnancy stage and may continue well into the postpartum period before improving.

Women may have trouble recalling names or words, keeping track of events or completing everyday tasks.

According to the author of the study Dr Zheng Sun of Baylor College of Medicine, about 80% of pregnant women report these changes. The researchers say that this condition does not appear to be a decline in intelligence or cognitive ability.

According to Reuters, Dr Yanlin He, another study leader, said, “The important point is that pregnancy does not simply make someone ‘less intelligent.’ The effects appear to be more subtle and specific to certain cognitive tasks.”

Also read: Vitamin D & Pregnancy: Could Vitamin D Deficiency Increase Risk Of Premature Birth?

Link Between Pregnancy Hormones And Memory

During pregnancy, estrogen levels increase drastically and reach its peak during the third trimester.

The researchers focused on estrogen receptor alpha in neurons located in the lateral hypothalamus. In experiments based on mice who were exposed to high estrogen level conditions like in pregnancy, these neurons became more active.

Those neurons send signals to the hippocampus, a brain region crucial for memory formation. The researchers found that increased activity in this region suppressed hippocampal activity and impaired performance on memory tests.

When researchers switched off the hypothalamus-to-hippocampus pathway, the memory problems in the mice were prevented. Activating the pathway, meanwhile, impaired memory even without elevated estrogen.

Removing estrogen receptors from the hypothalamic neurons also reversed the estrogen-related memory problems in the mice.

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Does Pregnancy Actually Make You Forgetful?

The researchers also assessed memory in 70 women, including women at different stages of pregnancy and women who were not pregnant.

Memory problems surfaced during late pregnancy stages and were linked with higher circulating estrogen levels. The researchers reported changes across several memory-related tasks.

But it is important to note that the researchers did not directly measure or manipulate this specific brain circuit in pregnant women. That means the human findings support the mechanism observed in mice, but do not prove that exactly the same circuit causes memory changes during human pregnancy.

The study has cemented evidence that many pregnant women experience forgetfulness, but it does not mean pregnancy causes permanent memory loss. For most women, pregnancy-related forgetfulness generally improves after childbirth.

The gut microbiome may influence how type 1 diabetes develops in children at high genetic risk, a new study suggests.

Researchers found that children whose gut microbiome stopped developing early had about three times the risk of developing type 1 diabetes or the immune attack that precedes it, compared with those whose microbiomes continued to mature.

The findings, published in Nature Metabolism, also showed that genetics influenced how strongly some microbiome patterns were associated with disease risk.

Type 1 diabetes affects more than 9 million people worldwide, including 1.8 million children and adolescents.

"Understanding the role of microbiome development in diabetes progression could lead to early prediction and prevention strategies, giving us more options to delay or even prevent the clinical manifestation of this disease," said co-corresponding author Daniel Wang, associate scientist with the Channing Division of Network Medicine in the Mass General Brigham Department of Medicine.

Study Tracked Children From Early Life

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The longitudinal observational TEDDY Study followed 887 children at high genetic risk of type 1 diabetes and analyzed more than 12,000 stool samples collected during their first six years.

Participants came from Finland, Germany, Sweden and the United States.

Because the immune system can attack insulin-producing cells years before symptoms appear, researchers counted both the first detection of this immune attack and a clinical diagnosis as disease-related outcomes.

They identified three microbiome development patterns: early-matured, late-matured and early-plateaued.

Children with early-matured microbiomes developed greater bacterial diversity during their first year. Those with late-matured microbiomes started more slowly but eventually caught up.

The early-plateaued group showed slow development that failed to catch up, with low bacterial diversity persisting through the first three years.

Early Plateau Linked To Higher Risk

Children with an early-plateaued microbiome had about three times the risk of developing type 1 diabetes or its preceding immune attack.

The association was also seen when the researchers analyzed the immune stage and clinical diagnosis separately.

The finding emerged from repeated stool sampling over time, suggesting a single microbiome snapshot could have missed the association.

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Microbiome Reflected Dietary Changes

The bacterial differences also reflected how the children's microbiomes adapted as their diets changed.

In the early-matured group, bacteria shifted sooner from milk-adapted species such as Bifidobacterium toward bacteria that break down dietary fiber.

In the early-plateaued group, the microbiome remained more focused on digesting milk sugars even after solid foods were introduced and relied on a narrower range of bacterial species.

Genetics Also Played a Role

Lead author Danyue Dong, a postdoctoral research fellow in the Channing Division of Network Medicine at Mass General Brigham shared that "genetic background" can also influence the risk. Dong noted that combining microbiome and genetic information gives a more accurate picture.

"By analyzing interactions between the microbiome and host genetics, we found genetic variants, particularly those involved in antimicrobial and antiviral immune responses, that shaped how strongly the late-matured pattern was related to disease risk. The early-plateaued pattern, by contrast, carried higher risk regardless of genetic background," the expert said.

What It Means for Prevention

The study was observational, so it cannot establish that microbiome changes cause type 1 diabetes. Clinical trials are needed to determine whether modifying the microbiome can reduce disease risk.

The findings also came from children already at high genetic risk, meaning they may not apply to the general population.

Researchers say future pediatric care could potentially include microbiome testing during the first years of life. However, approaches such as dietary supplements would need to prove effective in clinical trials before being used for prevention.