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

Musculoskeletal problems such as back pain, once more commonly associated with adulthood and old age, are increasingly being reported among schoolchildren, experts at the Indian Association of Physiotherapists (IAP) have warned.

Ahead of the World Physiotherapy Asia Western Pacific (WPAWP) Regional Conference 2026, IAP experts flagged a reported 40% rise in musculoskeletal problems among schoolchildren, citing sedentary lifestyles and poor movement habits as key concerns.

The experts called for greater focus on prevention, movement education and physical fitness from an early age.

“Back pain does not start in old age. We are seeing a concerning 40% rise in musculoskeletal problems among schoolchildren, and this should make us rethink how we approach preventive healthcare in schools,” Prof. Dr. Sanjiv K. Jha, President of the Indian Association of Physiotherapists (IAP), said.

He flagged concerns that long hours of studying and prolonged screen use are making children increasingly physically inactive. Reduced movement, along with inadequate strength, flexibility and fitness, may contribute to musculoskeletal problems and could have long-term consequences if not addressed.

“We need to shift from treating musculoskeletal problems after they appear to preventing them through early education, fitness and appropriate physiotherapy interventions,” Dr. Jha said.

Also Read: Gut Microbiome Linked To 3x Higher Type 1 Diabetes Risk In Children

Childhood Back Pain Is Already A Concern

Indian research indicates that musculoskeletal symptoms are a significant concern among school-going children.

A study of 934 children aged 8–15 years from four schools in Bhopal found that 55.9% reported pain during the previous 12 months, while 41.6% reported pain during the preceding 10 days and 21.3% had visited a doctor for the problem. The study also found that the average schoolbag weighed 16.5% of the students’ body weight.

Another study among schoolchildren aged 10–16 years in urban and rural areas of Khurda district, Odisha, found an 18.8% prevalence of musculoskeletal pain during the preceding year. The research examined factors including backpack weight, age, gender and body measurements.

Heavy Schoolbags Are Not The Whole Story

Read More: Are Children Breathing Clean Air Inside Classrooms? New European Study Raises Concern

Experts caution against attributing childhood back pain solely to heavy schoolbags. Scientific evidence suggests that musculoskeletal pain can have multiple contributing factors, including physical activity, movement habits, previous injuries, psychosocial factors, prolonged sitting and individual characteristics.

This points to the need for a broader approach to childhood musculoskeletal health rather than focusing exclusively on schoolbag weight.

“We should not totally link childhood back pain to a heavy-school-bag problem. Children need regular movement, physical fitness, strength, flexibility, good movement habits and awareness about how they use their bodies,” Dr. Ruchi Varshney, part of the IAP, said.

She added that physiotherapy can help schools introduce preventive programs focused on movement education, early identification of problems and healthy physical activity rather than waiting until pain becomes persistent.

Schools Can Play A Bigger Role

Physiotherapists believe schools can become important platforms for movement education, exercise, postural awareness, physical fitness, injury prevention, ergonomics, early screening and health promotion.

The larger message is that back pain should not be viewed as an inevitable problem of growing older.

Musculoskeletal health begins in childhood, and prevention should begin before pain becomes persistent.

Regular movement, physical fitness, strength and flexibility can help children develop healthy movement habits and support their musculoskeletal health as they grow.

Congenital heart disease (CHD) is not just a paediatric cardiac problem. It is a major public-health challenge. CHD is among the most common birth defects, affecting approximately 8–12 babies per 1,000 live births. In India, with a birth prevalence of around 9 per 1,000, this translates to approximately 2.4 lakh babies being born with CHD every year.

Indian consensus guidance has also estimated that CHDs may account for approximately 10% of infant mortality in the country. These numbers make one thing clear: we cannot treat congenital heart disease only after a child becomes sick. We need to find it earlier. And that is where newborn screening becomes a public-health priority.

The problem is not only CHD. It is missed CHD.

One of the biggest challenges is that a baby with a serious heart defect may look completely healthy at birth. Some critical congenital heart defects may have no obvious signs during the initial newborn examination. A baby may feed normally, have a normal colour and appear ready to go home—only to deteriorate days later when the circulation changes after birth.

By then, what could have been a planned referral can become an emergency. This is why “the baby looks fine” cannot be considered a heart check.

Also read: Elderly Diabetic With Rock-Hard Arteries Undergoes Advanced Calcium-Breaking Heart Procedure, Avoids High-Risk Surgery

Every newborn needs more than a visual assessment

A careful newborn examination remains essential, but it cannot identify every critical heart defect. This is where pulse oximetry can add another layer of protection. Pulse oximetry is a simple, non-invasive test that measures oxygen saturation. When performed alongside clinical examination, it can help identify babies with critical congenital heart disease who may otherwise be missed.

Importantly, pulse oximetry does not diagnose every form of CHD and a normal reading does not rule out all heart defects. It is a screening tool—not a substitute for clinical assessment or echocardiography. Indian studies have demonstrated the potential value of combining clinical examination with pulse oximetry. In one study of asymptomatic newborns, pulse oximetry alone detected 80% of critical CHD cases, clinical examination detected 60%, while combining the two identified all cases in that study.

This is where public health policy matters

The question should no longer be: “Can we screen some babies?” The question should be: “How do we ensure that no baby is missed simply because screening was not available?”

India has already demonstrated that population-level screening can work. Kerala's state-wide newborn programme incorporated pulse oximetry screening into government delivery centres. By 2019, more than 157,000 newborns had been screened, with the programme identifying 134 cases of CHD, including 74 critical cases.

This is the kind of approach that needs to move from individual hospital initiatives towards standardised newborn-care pathways across the country. At Cloudnine Hospitals, we have screened more than 3 lakh babies so far. Through this screening, we identified 92 cases of Critical Cyanotic Congenital Heart Disease (CCCHD). These findings highlight the value and cost-effectiveness of routine pulse oximetry screening in newborns.

Also read: Menopause & Heart Health: Why This Transition Can Be A Turning Point for A Woman’s Cardiovascular Future

Screening without referral is not enough

However, screening is only the first step.

A public-health programme must connect the entire chain:

Screen → Confirm → Refer → Treat → Follow up

A baby who screens positive needs timely access to echocardiography, paediatric cardiology, neonatal stabilisation and, when required, cardiac intervention. This is one of India's biggest challenges. Paediatric cardiac services, specialists, diagnostic facilities and transport systems are unevenly distributed, particularly between urban and rural areas.

Indian literature has highlighted the gap between the enormous number of babies who may require cardiac care and the country's capacity to provide timely specialised treatment. Therefore, universal screening without a strong referral and treatment network cannot solve the problem.

Early diagnosis changes the equation

The good news is that the story of CHD is no longer one of inevitable poor outcomes. With timely diagnosis and access to appropriate treatment, more than 90% of people born with CHD can survive into adulthood with good long-term outcomes. Treatment may include monitoring, medicines, catheter-based procedures, surgery or staged interventions, depending on the defect.

The challenge, therefore, is increasingly about closing the gap between what modern medicine can achieve and what a child actually receives. A child cannot benefit from a life-saving cardiac intervention if the heart defect is never detected, if the diagnosis is delayed, or if the family cannot reach the right centre in time.

Also read: Stopping Ozempic, Wegovy, Mounjaro Linked To 22% Higher Heart Attack, Stroke Risk: Study

The message to parents is simple

Parents should know that congenital heart disease is not always visible at birth. During pregnancy, recommended antenatal scans can help identify several structural heart abnormalities. After birth, a thorough newborn examination and, where available and appropriate, pulse oximetry screening can provide additional opportunities to detect critical heart disease.

Parents should also seek prompt medical attention if their baby develops:

• Difficulty or rapid breathing
• Bluish or greyish lips or skin
• Poor feeding or tiring during feeds
• Excessive sweating while feeding
• Poor weight gain
• Unusual lethargy or recurrent episodes of illness

These signs do not necessarily mean that a baby has CHD, but they should never be ignored.

From awareness to action

For too long, congenital heart disease has been viewed primarily as a specialist problem. It is time to view it as a newborn-health priority. If approximately 2.4 lakh Indian babies are born with CHD every year, then early identification cannot remain dependent on whether a particular hospital has a screening protocol or whether a family happens to reach a cardiac centre in time.

We need standardised newborn screening, trained healthcare professionals, reliable referral pathways, accessible paediatric cardiac services and long-term follow-up.

This is what public-health action looks like.

Don’t Miss a Beat

“Use Heart for Action” should mean more than awareness on World Heart Day. For newborns, it should translate into action at the point where it can make the greatest difference—before a silent heart defect becomes a life-threatening emergency. Each can be an opportunity to detect a problem earlier.

We cannot prevent every congenital heart defect. But we can work towards preventing a missed diagnosis from becoming a missed opportunity to save a child's life. Because every newborn deserves a heart check—and when it comes to a baby's heart, we cannot afford to miss a beat.

A child's lungs continue to develop well into adolescence, laying the foundation for respiratory health throughout life. When children grow up with smaller lung capacity, it means their lungs are unable to reach their full growth potential.

This can affect how efficiently the body takes in oxygen and may influence physical stamina, exercise tolerance and overall well-being. While the consequences are not always immediately visible, lung health in childhood can shape respiratory health decades later.

What Can Affect Lung Growth?

Lung development is influenced by several factors, beginning even before birth. Premature birth and low birth weight can affect early lung growth. During childhood, recurrent respiratory infections, poorly controlled asthma, exposure to tobacco smoke and prolonged exposure to air pollution may also influence lung function.

Nutrition, physical activity and genetic factors can contribute to differences in lung capacity between children.

How Can Smaller Lung Capacity Present?

Some children may have reduced lung function without obvious symptoms. Others may show signs during physical activity or respiratory infections.

Parents may notice:

• Breathlessness or unusual fatigue during play or exercise
• Difficulty keeping up with peers during physical activities
• Persistent cough or recurrent wheezing
• Frequent respiratory infections or prolonged recovery after illness

These symptoms can occur with several respiratory conditions, so they should not automatically be attributed to low fitness or smaller lungs.

Can Lung Function Be Improved?

Management depends on why lung function is reduced. When asthma or another airway condition is present, appropriate inhaled medicines can help control inflammation and improve breathing. Children with specific chronic respiratory conditions may benefit from supervised breathing exercises, respiratory physiotherapy or pulmonary rehabilitation.

Where poor nutrition or inadequate growth is a contributing factor, nutritional support may also be recommended. The focus is not simply on increasing lung capacity, but on treating the underlying condition and helping the child achieve the best possible lung function for their age and health.

What Can Parents Do?

Several everyday measures can support respiratory health while the lungs are developing. Regular age-appropriate physical activity, adequate nutrition and sufficient sleep are important.

Eliminating and reducing exposure to cigarette smoke, indoor pollutants and poor outdoor air quality can also help immensely. Recommended vaccinations and timely treatment of respiratory infections may further reduce the impact of preventable illness.

When Should Lung Function Be Evaluated?

Persistent respiratory symptoms, repeated chest infections, unexplained exercise intolerance, or a history of premature birth may warrant medical evaluation.

Depending on the child's age and symptoms, assessment may include a physical examination, oxygen measurement, lung function tests such as spirometry and Forced Oscillometry testing to identify the underlying cause and help determine whether medication, respiratory therapy, nutritional support, or other interventions are appropriate. In addition, sometimes undetected cardiac issues could be contributing and need attention and evaluation.

Protecting Lung Health Early

Childhood is an important period for establishing lifelong respiratory health. Minimizing exposure to harmful pollutants, encouraging physical activity and addressing respiratory problems early can help children reach their individual lung growth potential. The aim is not simply to measure how much air the lungs can hold, but to ensure they function as effectively as possible throughout childhood and into adulthood.

Food plays a very important role in this, as the saying goes, “we are what we eat”. Staying close to home-cooked, uncomplicated food is the key rather than app-based fast-food cravings.

(By Dr. Viny Kantroo, Senior Consultant, Pulmonary, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi)