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

World map based on the United Nations population projection shows that 85 per cent of babies in 2026 will be born in Asia and Africa. The probabilistic population projection for 2026 is based on the World Population Prospects 2024.

2026 Baby Boom: 64.9 Billion Births In Asia

The map reveals that Asia is expected to see 64.9 billion births in 2026. This will account for roughly 49 per cent of all births worldwide. While fertility rates in countries like China, Japan and South Korea have declined, Asia's population still is keeping up and is at the center of global demographics.

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2026 Baby Boom: 47.6 Billion Births In Africa

Second on the list is Africa, with expected numbers of 47.6 billion births in 2026. This represents 35.9 per cent of the global total. This is also true due to continent's high fertility rates and young population structure..

2026 Baby Boom: How Does the Rest Of The World Look Like?

• Latin America and Caribbean are expected to see 9.3 billion births or a total of 7 per cent of the total.
• Europe accounts for only 4.6 per cent of the birth rate as compared to the global population.
• North America shares a 3 per cent, which also reflects low fertility rates, despite a population growth driven by migration.
• Oceania contributes 0.5 per cent of births.
• Antarctica has no permanent population.

2026 Baby Boom: South Korea's Birth Rate Increased

South Korea’s birth rate increased for the second consecutive year in 2025, offering cautious hope for a country that has grappled with a demographic crisis for nearly a decade.

Preliminary figures from the Ministry of Data and Statistics show the total fertility rate, the average number of children a woman is expected to have in her lifetime, reached 0.80 in 2025, up from 0.75 in 2024. Births had already begun recovering in 2024 following the pandemic, aided by government support measures, after eight straight years of decline that pushed the rate to a record low of 0.72 in 2023 amid soaring housing costs and greater female workforce participation.

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The crude birth rate rose to 5.0 births per 1,000 people in 2025 from 4.7 the year before. For comparison, China recorded 5.6 last year, Taiwan 4.6 and Japan 5.7 in 2024, where the overall trend is still downward.

The rebound has been quicker than the government’s optimistic forecast, which had projected 0.75 in 2025 and 0.80 in 2026, with fertility expected to cross 1.0 by 2031.

Marriage rates, often a leading indicator of future births with a lag of one to two years, climbed 8.1% in 2025 after jumping a record 14.8% in 2024. Officials attributed this partly to a larger population in their 30s and gradually shifting social attitudes.

The biggest rise in births occurred in the capital. Seoul’s fertility rate increased 8.9% to 0.63 from 0.58 in 2024, though it remains the lowest in the country.

Experts say the numbers still require careful interpretation because demographic composition changes can affect statistics. Even so, they view the improvement as a positive signal that may encourage more people to consider parenthood.

A 2024 government survey found 52.5% of South Koreans held positive views about marriage, up from 50.1% in 2022, and respondents ideally wanted 1.89 children on average.

Births increased 6.8% to 254,457 last year, the biggest rise since 2007. However, deaths also grew 1.3% to 363,389, meaning the population declined naturally for the sixth year in a row.

Infertility is no longer limited to couples in their 30s and 40s. Doctors are now seeing a steady rise in patients in their 20s seeking help to conceive. According to Dr. Bushra Khan, Fertility Specialist at Nova IVF Fertility, Kharadi, Pune, this shift is both real and concerning.

“Until a few years ago, fertility problems were mostly age related. Today, we are seeing women between 23 and 29 struggling to conceive,” she said. “Many assume they are too young to have fertility issues, so they delay medical advice.”

Experts say modern lifestyle factors, stress, and untreated health conditions are affecting reproductive health earlier than expected. The encouraging part, however, is that early diagnosis and treatment can significantly improve outcomes.

Common Fertility Issues Seen In Young Adults

In women, doctors frequently diagnose polycystic ovary syndrome, ovulation disorders, thyroid imbalance, endometriosis and pelvic infections. Some also show poor egg quality despite being in their 20s.

Men are not unaffected. Low sperm count, poor sperm movement and hormonal imbalance are becoming increasingly common. Obesity, smoking, alcohol consumption and prolonged laptop use that increases heat exposure can affect sperm health.

“These problems require timely evaluation rather than waiting for years,” Dr. Khan explained. “Early intervention keeps treatment simpler and more effective.”

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Lifestyle Is A Major Contributor

Unhealthy diets, lack of physical activity, high stress and disturbed sleep patterns play a major role. Increasing obesity and insulin resistance among young adults also interfere with ovulation and sperm production.

Pollution and untreated infections further complicate reproductive health. In some cases, genetic factors may also contribute.

“Fertility health reflects overall health,” Dr. Khan said. “What we eat, how we sleep and how stressed we are directly impact reproductive hormones.”

Warning Signs Young Couples Overlook

Many young adults dismiss early symptoms because they believe infertility affects only older individuals. Doctors advise not ignoring the following:

• Irregular or painful periods
• Acne and excess hair growth
• Sudden weight gain or loss
• Persistent fatigue
• Low libido or erectile issues
• Difficulty conceiving after one year of trying

“Fertility issues are now being detected even in people aged 20 to 27,” Dr. Khan noted. “Ignoring symptoms can worsen hormonal imbalance over time.”

Risks Of Delayed Treatment

Delaying treatment may reduce egg or sperm quality and increase emotional stress. Couples may later require more complex procedures.

“Seeking help early improves both success rates and peace of mind,” she added.

How Assisted Reproductive Technologies Help

Assisted Reproductive Technologies such as ovulation induction, intrauterine insemination and in vitro fertilization are highly effective in younger patients because egg and sperm quality is generally better.

These treatments help conditions like PCOS, blocked tubes, severe male factor infertility and unexplained infertility.

Egg freezing is another option that allows women to preserve fertility for medical or personal reasons.

“Egg quality declines after the mid 30s. Preserving eggs earlier gives women reproductive flexibility,” Dr. Khan said. “The most important step is awareness and timely consultation.”

Doctors stress that fertility awareness should begin early. Monitoring symptoms and consulting a specialist promptly can prevent complications and significantly improve chances of conception.

Seeing your child suddenly screaming at night, with wide eyes and thrashing limbs, can be deeply unsettling. However, remaining calm and focusing on safety is crucial for parents during the sleep terror episodes, said health experts.

Sleep terrors, also known as night terrors, are episodes of sudden fear, screaming, or intense distress that occur during sleep.

The condition is more common in children, especially between the ages of 3 and 8 years, as their sleep patterns are still maturing.

Unlike nightmares, which usually happen during dreaming (REM sleep) and are often remembered, sleep terrors occur during deep non-REM sleep.

Dr Preeti Singh, Senior Consultant, Clinical Psychology, Max Super Speciality Hospital, Dwarka told HealthandMe, that while it may be frightening to witness, especially for parents, sleep terrors themselves are usually not harmful.

Although most kids outgrow this naturally, if the episodes are violent or very frequent, consult a specialist, added Dr Sudhir Kumar, a neurologist at Apollo Hospitals, Hyderabad.

What Are Sleep Terrors

During sleep terror, the child may sit up abruptly, shout, appear frightened, sweat, breathe rapidly, and be difficult to console. In most cases, they do not recall the episode the next morning.

Sleep terrors typically occur in the first third of the night, during deep sleep (slow-wave sleep). They are considered a type of parasomnia, meaning an unusual behavior during sleep.

Dr Kumar, in a post on social media platform X, explained that unlike a bad dream, a sleep terror happens in deep sleep (Stage N3).

It is characterized by abrupt sitting up/screaming, with physical signs that include a fast heart rate, sweating, and dilated pupils.

"It is 11 PM. Your child suddenly sits up, screams at the top of their lungs, and looks terrified. They are not responding to you, and they seem to be looking right through you. This is likely a sleep terror (night terror), a common NREM sleep parasomnia in children aged 3-12,” said Dr Kumar, popularly known as the Hyderabad doctor, on X.

The expert noted that the children are unlikely to recognize the parents and be "consoled" during the episodes.

What Factors Trigger Sleep Terrors

• Sleep deprivation or irregular sleep schedules
• Fever or illness
• Emotional stress or anxiety
• Major life changes or trauma
• Family history of parasomnias
• Certain medications

For children, sleep terrors are often developmental and tend to reduce as the nervous system matures, Dr Singh told HealthanMe.

How Can Parents Respond?

Parents often feel alarmed during a sleep terror episode, but the key is to remain calm, the experts said. They said during an episode:

• Do not try to fully wake the child, as this may increase confusion and agitation.
• Gently ensure the child is safe and cannot injure themselves.
• Speak softly and reassuringly, even if they do not respond.
• Wait for the episode to pass, which usually happens within a few minutes.

Other preventive measures include:

• Maintaining a consistent bedtime routine
• Ensuring the child gets adequate sleep
• Reducing screen time before bed
• Managing stress during the day
• Creating a calm and secure sleep environment

How To Manage

Most children do not require medical treatment, as sleep terrors usually resolve on their own with age. Treatment is considered when episodes are frequent, severe, cause injury, or significantly disrupt family life.

However, addressing sleep deprivation, treating any underlying medical conditions (e.g., sleep apnea), counseling or stress management strategies can help.