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

When Emily Hughes saw that her 18-month-old daughter, Scarlett, had a swollen knee in late 2023, she initially thought it might be an injury from the toddler’s routine playtime. Scarlett was energetic and adventurous, and the swelling did not appear to cause her pain.

But the swelling did not improve, and further examinations eventually led to a diagnosis of juvenile idiopathic arthritis (JIA), a chronic inflammatory condition that affects children.

Hughes, who lives in Australia, told Mamamia that several doctors initially found no cause behind her daughter’s symptoms. The situation changed in February 2024, when Scarlett’s knee became hot, painful and more severely swollen. She could no longer bear weight on the affected leg. “She wouldn’t bear weight, and it was even more swollen,” Hughes said.

Scarlett was taken to the Royal Children’s Hospital in Melbourne, where doctors initially thought it was septic arthritis, a serious joint infection. Investigations failed but the family continued consulting specialists.

By May, after other possible explanations got investigated, Scarlett was referred to a rheumatologist and diagnosed with juvenile arthritis affecting three joints.

Now four years old, Scarlett is in remission and has returned to physical activities like climbing and doing cartwheels. Her experience highlights why stubborn joint swelling and changes in a young child’s movement deserve emergency medical attention, even when the child is not in pain.

What Is Juvenile Idiopathic Arthritis?

Also read: Women And Arthritis: Why Risk Increases After 40

Juvenile idiopathic arthritis is the most common form of chronic arthritis in children. It refers to a group of several conditions in which the immune system triggers inflammation in the joints by mistake. Although genetic and environmental factors may contribute, the exact cause is unknown.

The condition can affect children younger than 16 and may involve one or several joints. The knees, ankles, wrists and elbows are commonly affected.

Unlike arthritis, JIA can begin during toddlerhood. Its symptoms may also be difficult to recognise as young children cannot always describe pain, stiffness or discomfort accurately.

There is no single test that confirms JIA. Doctors start by assessing the child’s symptoms, medical history and physical examination, and may use blood tests and imaging to investigate inflammation and rule out other conditions.

Signs Of Juvenile Arthritis Parents Should Not Ignore

Also read: Arthritis Day: Stanford Researchers Explore Possibility To Treat Osteoarthritis Without Knee Replacement Surgery

According to the US National Institute of Arthritis and Musculoskeletal and Skin Diseases and the American Academy of Pediatrics, parents should watch for the following symptoms:

1. Continued joint swelling

A knee, ankle, wrist or other joint that remains swollen should be assessed on priority. In JIA, painless swelling may occur even when the child seems comfortable.

2. Morning stiffness

Children may struggle to move a joint after waking up or after sitting still for a long time. Stiffness may improve as they become more active during the day.

3. Limping or reluctance to walk

A toddler who starts limping, avoids putting weight on one leg or has difficulty walking may be experiencing joint inflammation.

4. Difficulty bending or straightening a joint

Limited movement is also one of the signs. A child may struggle to straighten an elbow, bend a knee or move a limb as freely as before.

5. Changes in play and everyday activities

A child who suddenly avoids climbing, running or playing, or struggles with activities they previously dud easily, may have pain or stiffness.

Some children with JIA may also experience fatigue, fever, rash or reduced appetite, depending on the type of disease. Untreated inflammation can damage joints and interfere with a child’s movement and development. Early diagnosis and treatment aim to control inflammation, maintain joint function and help children maintain their usual activities.

JIA can also affect the eyes. Some children develop uveitis, inflammation inside the eye that may cause no obvious symptoms initially but can threaten vision if left untreated. Regular eye examinations are therefore an important part of JIA.

For every woman pregnancy is a beautiful and dream journey, but from the perspective of heart-health , it acts as a “natural stress test” for the body. The best part is most women recover completely after childbirth. However, certain complications such as preeclampsia, high blood pressure, gestational diabetes, preterm delivery, or poor fetal growth can sometimes be early warning signs of future cardiovascular risk.

As a cardiologist, I want women to know that preeclampsia does not simply end when pregnancy ends. It can signal a higher risk of high blood pressure, diabetes, heart disease and stroke later in life. Gestational diabetes also increases future cardiometabolic risk.

This does not mean you will develop heart disease. It means you have an opportunity to be proactive.

Also read: Maternal Immunisation: The Forgotten Half of Protecting a Baby's Health

What should be your postpartum action plan?

1. Check your blood pressure regularly, especially after preeclampsia or gestational hypertension.

2. Check blood sugar after gestational diabetes and continue recommended long-term screening.

3. Know your numbers: monitor cholesterol, weight and other cardiovascular risk factors.

4. Rebuild healthy habits: gradually return to regular exercise, eat a heart-healthy diet, avoid smoking and prioritise sleep.

5. Tell your doctor your pregnancy history—it is an important part of your lifelong heart history.

Your pregnancy may be over, but not your heart health journey, it continues for life time. Early awareness gives you the power to prevent problems before they begin.

By Dr. Sunil Kumar Mandal, MBBS, MD , DM (Cardiology), Senior Consultant Interventional Cardiologist

Vaccination during pregnancy protects more than just the mother. Vaccines such as Td, Tdap, and influenza (when recommended) help pass protective antibodies to the baby, providing valuable immunity during the first six months of life.

When people think about vaccination, they usually think about babies receiving their first vaccines after birth. However, an important part of a child's protection actually begins during pregnancy.

Maternal immunisation helps protect both the mother and her baby by allowing protective antibodies to pass through the placenta before birth. These antibodies provide the newborn with temporary immunity during the first few months of life, when the baby's immune system is still developing and routine childhood vaccines have not yet become fully effective.

Despite its importance, awareness about maternal immunisation remains low, with many women knowing only about the Td vaccine while being unaware of the benefits of Tdap and influenza vaccination when recommended.

What is maternal immunisation?

Maternal immunisation refers to vaccines that are recommended during pregnancy to protect the mother from certain infections while also passing protective antibodies to the unborn baby.

During the third trimester, these antibodies cross the placenta and help protect the newborn from serious illnesses during the first six months of life. This protection is especially important because young infants are more vulnerable to infections and cannot receive all vaccines immediately after birth.

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Important vaccines during pregnancy

Td (Tetanus and Diphtheria): The Td vaccine is routinely recommended during pregnancy. It protects the mother against tetanus and diphtheria while also helping protect the newborn from neonatal tetanus.

Tdap (Tetanus, Diphtheria and Pertussis): In many situations, doctors may recommend the Tdap vaccine during pregnancy. It also protects against pertussis (whooping cough), a highly contagious infection that can be life-threatening for young babies. Vaccination during pregnancy allows antibodies to reach the baby before birth, reducing the risk of severe illness in early infancy.

Influenza (Flu) Vaccine: Pregnant women are at a higher risk of developing complications from influenza. When recommended by the treating doctor, the influenza vaccine helps protect both the mother and the baby during flu season.

Why it matters for the newborn

A newborn's immune system is still immature, making babies more susceptible to infections. The antibodies received from the mother act as the baby's first shield against disease until the infant starts receiving routine childhood vaccines and develops their own immunity. This early protection can reduce the risk of severe infections during one of the most vulnerable stages of life.

Also read: The Silent Struggle Of Raising A Child With Mental Health Challenges: How Parents Can Cope With Stigma

Tips for expectant mothers

• Discuss maternal vaccination during your first antenatal visit.

• Receive the Td vaccine according to your doctor's advice.

• Ask your obstetrician whether Tdap is recommended during your pregnancy.

• Take the influenza vaccine if advised by your doctor.

• Attend all scheduled antenatal check-ups.

• Maintain a healthy diet, adequate sleep, and good hydration during pregnancy.

• Encourage family members and caregivers to stay up to date with their vaccinations to help protect the newborn.

• Ensure your baby receives all routine childhood vaccines on time after birth.

By discussing vaccination early in pregnancy and following medical advice, expectant mothers can provide their newborn with valuable protection during the first six months of life, giving them a healthier and safer start.