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

Shoko Kawata, Japan’s first mayor to take maternity leave, has been named one of TIME Magazine’s 100 most influential rising stars.

The 35-year-old mayor of Yawata City in Kyoto Prefecture sparked a national debate, earlier this year, after announcing she would take maternity leave following the birth of her first child. Her decision came as Japan struggles with declining birth rates and efforts to support women in work and public life.

“I was so surprised because the reaction was so big,” Kawata told the BBC.

Kawata gave birth to a baby girl on September 15. Her decision drew both support and criticism, with some praising her for making it easier for women to enter politics, while critics questioned whether elected officials should step away from public duties after childbirth.

Kawata Took Maternity Leave To Shape Policies

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Kawata defended her decision, saying women should not have to choose between public office and starting a family.

“If we were to criticise politicians taking maternity leave, it means we are effectively excluding all women in their 20s through 40s - women who are capable of becoming pregnant - from public office,” she told the BBC.

Japan provides maternity leave for municipal employees, but there is no specific legal framework for local elected officials. Kawata therefore worked with her office to arrange a 16-week transfer of authority to Deputy Mayor Shigeto Nose, while planning to work remotely when possible.

After giving birth, Kawata said her experience as a new mother would also shape the policies she pursues.

“I want to confront the many challenges facing parents and children today from that same perspective, as someone living through them myself,” she wrote on X.

Why Postpartum Recovery Matters For Working Women

Kawata’s experience also highlights the physical and emotional demands women face after childbirth.

While attention often shifts to the newborn, mothers also need adequate rest, nutrition, medical care and emotional support. For working women, pressure to return to work can add to the challenges of postpartum recovery.

The World Health Organization says the first six weeks after childbirth are a critical period for both mothers and babies, with a large proportion of maternal and infant deaths occurring during the postnatal period.

What Happens To The Body After Childbirth?

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After delivery, the uterus gradually contracts back towards its pre-pregnancy size, which can cause cramping. Women can also experience postpartum bleeding and discharge, known as lochia, for several weeks.

Hormonal changes, particularly the rapid drop in estrogen and progesterone, can affect mood. Breast engorgement, nipple sensitivity and pelvic-floor changes can also occur, sometimes causing urinary leakage or discomfort.

Postpartum Mental Health Also Matters

New mothers are also adjusting to sleep disruption, feeding and the demands of caring for a baby.

Many women experience the “baby blues,” a temporary period of mood changes after childbirth. This is different from postpartum depression, which is more severe and can last longer.

Adequate rest, practical support, medical follow-up and mental-health care can all play an important role in postpartum recovery.

Unsafe sleep factors, including soft bedding, sharing a sleep surface with another person or animal, and sleeping on a surface other than a crib or bassinet, were identified in 73% of sudden unexpected infant death (SUID) cases in the US, according to a new report from the US Centers for Disease Control and Prevention (CDC).

SUID includes sudden infant death syndrome (SIDS), accidental suffocation and strangulation in bed, and deaths from unknown causes. In 2024, SUID claimed the lives of about 3,400 babies in the US.

Even after decades of public health efforts to promote safer sleep practices, sleep-related deaths remain a major cause of infant mortality.

What Did The CDC Report Find?

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The report analyzed 4,861 SUID cases recorded between 2020 and 2024 across 31 US jurisdictions.

The CDC found that 73% of the deaths involved at least one unsafe sleep factor. These included:

• 78% involved soft bedding.
• 75% occurred on a sleep surface other than a crib or bassinet.
• 59% involved sharing a sleep surface with another person or animal.
• 46% of infants were found sleeping on their stomach or side rather than on their back.
• 28% had documented full airway obstruction involving the nose and mouth, neck, or chest.

These categories could overlap, meaning an infant could have had more than one unsafe sleep factor.

Most SUIDs Occurred In Young Infants

The CDC found that most deaths occurred among infants who were:

• 0–3 months old: 66%
• Male: 57%
• Black or African American: 38%
• White: 37%
• Born at 37 weeks or later: 74%
• Insured by Medicaid: 69%

What Is A Safe Sleep Environment?

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The American Academy of Pediatrics (AAP) recommends a safe sleep environment to reduce the risk of sleep-related infant deaths.

The AAP recommends placing babies on their backs to sleep, using a firm, non-inclined sleep surface, room-sharing without bed-sharing, and avoiding soft bedding and overheating.

It also recommends human milk feeding, avoiding exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs, routine immunization, and pacifier use as measures associated with lower SIDS risk.

“Babies should always be placed on their backs to sleep. Tummy time is important for developing strength and motor skills, but it should take place only when the baby is awake and being actively supervised,” Dr. Leana Wen, an emergency physician and clinical associate professor at George Washington University, was quoted as saying by CNN.

Once babies can roll from their backs to their stomachs and back again on their own, parents do not need to keep repositioning them during sleep. However, they should still place babies on their backs at the start of every sleep.

What Should Be In A Baby’s Crib?

Wen recommends that the crib should be empty or nearly empty. Parents should use a firm mattress covered with a fitted sheet and avoid pillows, blankets, quilts, bumper pads, and other soft objects.

If parents are concerned about the baby getting cold, they can use a wearable blanket or well-fitting sleep clothing instead of a loose blanket.

Room-Sharing Is Recommended, Not Bed-Sharing

The AAP recommends room-sharing without bed-sharing, ideally for at least the first six months.

This means keeping the baby’s crib or bassinet close to the parents’ bed for easier feeding and comforting, while ensuring the baby sleeps on a separate surface.

Feeding a newborn is one of the first and most important decisions parents make after birth. There is often debate around breastfeeding versus formula feeding. It is necessary to know the difference between exclusive breastfeeding and formula feeding to help families make informed choices based on the baby’s needs and even the mother’s health. Here, an expert explains both breastfeeding and formula feeding.

Are you new parents?

Know that caring for a newborn usually involves many questions about feeding. Some mothers tend to exclusively breastfeed, while others use formula due to various issues such as low milk supply or other circumstances.

But remember that every family’s situation is different, and parents should make feeding decisions only after consulting the doctor. The priority should be to give the baby safe, adequate nutrition for prompt growth and development.

Also read: Don’t Miss a Beat: Why Every Newborn Deserves a Heart Check

All you need to know about exclusive breastfeeding

Exclusive breastfeeding means feeding a baby only breast milk for the first six months of life. So, the baby will not be given water, formula, juice, or solid foods unless the doctor recommends. So, breast milk consists of nutrients, antibodies, and healthy fats, which are important for the baby’s growth and brain development. Breast milk is important for the baby and can help prevent infections, diarrhoea, and respiratory illnesses, and boosts the baby’s immunity.

Talking about formula feeding, this means giving a baby specially prepared infant formula to provide the nutrients needed for growth. So, formula milk is given when breast milk cannot be given to the baby. Now, modern infant formulas are carefully developed to support healthy growth. However, it doesn’t contain the natural antibodies and immune-protective factors that are present in breast milk. Formula milk should always be prepared safely as per the doctor’s instructions to reduce the baby’s chances of infections or any nutritional problems.

This is what parents should note

Breastfeeding is crucial for the baby as it tends to provide complete nutrition and health benefits for both mother and baby. It also helps enhance the mother and the baby’s bond and reduces the mother’s risk of breast and ovarian cancers. However, some women will be unable to breastfeed their babies due to certain medical conditions, medications, insufficient milk supply, or other challenges.

So, in such a situation, infant formula is a safe and nutritious alternative when used correctly under medical guidance. Even those babies who are formula-fed can also grow and develop well when they receive appropriate nutrition, are vaccinated, and are taken for regular health check-ups. Instead of comparing feeding methods, ensure to feed the baby well.