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

Childhood myopia is emerging as a major public health concern in India, and is beyond the need for spectacles, said health experts from All India Institute of Medical Sciences, New Delhi.

Myopia or nearsightedness is a common vision condition where close-up objects appear clear, but distant objects look blurry.

Recent estimates suggest that by 2050, nearly half of the global population may be affected by myopia. In India, prevalence rates among school-going children have risen sharply over the years, with urban studies indicating nearly 14 per cent prevalence, while rural regions have witnessed a rise from 4.6 per cent to 6.8 per cent over the past decade.

“Childhood myopia is no longer just about children needing spectacles earlier in life; it is increasingly becoming a serious long-term eye health concern," said Dr Jeewan Singh Titiyal, President of All India Institute of Medical Sciences Rajkot (AIIMS Rajkot).

High myopia can:

• permanently alter the structure of the eye,
• significantly increase the risk of retinal detachment,
• lead to glaucoma,
• cause cataract,
• lead to irreversible vision loss later in life.

“Combating childhood myopia requires a collective effort involving families, schools, healthcare systems, and policymakers. School environments must encourage outdoor exposure and healthier visual habits, while parents need to monitor screen dependency and ensure balanced lifestyles,” said Dr Rohit Saxena, Senior Pediatric Ophthalmologist, RP Singh AIIMS, New Delhi.

New Myopia Prevention Guidelines

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In response to the alarming rise in childhood myopia across India and globally, the All India Ophthalmological Society (AIOS) has released a comprehensive Consensus Guideline on “Prevention and Management of Childhood Myopia” as part of World Myopia Week 2026, held from May 18 to 24.

Dr Rohit, who is also the Program Director – Myopia Guideline, urged ensuring that adequate sleep, nutrition, and physical activity are not compromised.

“Early diagnosis and timely management can significantly improve outcomes and help protect children from avoidable visual impairment and future sight-threatening complications,” he said.

Dr Jeewan, also the President of AIOS, added that, unfortunately, many children fail to report blurred vision because they do not realize what normal sight should feel like.

The experts attribute the surge in childhood myopia to lifestyle changes accelerated over recent years, including prolonged screen exposure, increasing academic pressure, reduced outdoor activity, and extended periods of near work.

The transition toward digital learning environments has further contributed to children spending 4–6 hours or more daily on screens, often with inadequate visual hygiene practices.

The AIOS Guidelines And The 20-20-20 Rule

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The new recommendations reinforce the importance of the widely advocated 20-20-20 rule, encouraging children to take a 20-second break every 20 minutes and focus on an object 20 feet away to reduce eye strain.

The newly released AIOS guidelines also strongly emphasize preventive strategies, including:

• annual eye examinations,
• school vision screenings,
• limiting recreational screen time,
• maintaining appropriate reading distance,
• ensuring adequate lighting during study,
• encouraging children to spend at least two hours outdoors daily.

“The prevention and management of childhood myopia require a shift from reactive treatment to proactive prevention. Environmental factors such as prolonged near work, excessive digital exposure, and reduced outdoor time are modifiable risks that demand immediate societal attention," said Dr Namrata Sharma, Professor of Ophthalmology, All India Institute of Medical Sciences, Delhi.

The guidelines also provide insights into currently available myopia control interventions, including:

• atropine eye drops,
• specialized myopia control spectacles,
• orthokeratology,
• soft multifocal contact lenses.

There has been a significant rise in the number of children diagnosed with kidney stones, with some reporting a doubling or quadrupling in incidence over the last 15-20 years. Also, the number of surgical cases related to kidney stones has increased.

While kidney stones are typically associated with adults, they are now being diagnosed in younger children, including infants. The rise in kidney stones among children is a complex issue with multiple contributing factors, including dietary changes, obesity, and possibly environmental factors.

What Is A Kidney Stone?

Kidney stones are deposits of different minerals that can accumulate in the urinary tract. They can travel from the kidney, down the urinary tract, to the bladder and eventually be urinated out.

Some cases require surgical intervention. If left untreated, kidney stones can cause damage to the kidney, serious infection of the urinary tract, and, over time, damage the function of the kidney.

Why Kidney Stones Are Rising?

A major contributor to this rise has been dietary changes like increased consumption of processed foods, high-sodium foods, and sugary drinks, coupled with lower water intake. Also, the growing prevalence of childhood obesity is another contributing factor.

Immobile patients are also more at risk due to decreased flow of urine that can lead to stasis and then to kidney stone formation. Antibiotic use (which can affect gut flora that metabolize oxalate), and potentially even climate change, leading to dehydration, may also play a role.

Some children may be predisposed to kidney stones due to inherited disorders that affect how their bodies process certain minerals.

Prevention Is Key

As always, prevention is better than a cure. So, as parents, there are a few things that can be done so that children can avoid developing stones.

Promote healthy diets: Encourage children to consume a balanced diet low in sodium, processed foods, and sugary drinks, while ensuring adequate calcium intake. Eating out less and cooking meals at home can make sure this happens.

Promote an active lifestyle: Encouraging children to go outdoors to play and exercise can play a big role in preventing childhood obesity, which can also be a contributing factor to stones.

Increase fluid intake: Encourage children to drink plenty of water throughout the day. Having a water bottle for kids to carry at school and using water drinking tracking apps to help keep them accountable and increase their water intake.

Avoid unnecessary antibiotics: Avoid unwarranted usage of antibiotics in children for minor ailments where they are not indicated.

Address underlying medical conditions: If a child has other medical conditions that increase the risk of kidney stones, these should be managed appropriately.

Monitor and manage: Early detection and management of kidney stones in children are crucial to prevent complications and recurrence.

To sum up, by promoting healthy habits and addressing underlying medical conditions, parents and healthcare professionals can help reduce the risk of kidney stones in children.

Pregnancy is probably one of the most important periods in a woman’s life during which her decisions regarding nutrition, exercise, and many other factors can directly affect the health of the fetus.

Today, doctors are paying more attention to the impact that modern lifestyle trends have on pregnant women and their babies, since improper nutrition, sedentary lifestyle, too much use of electronic devices, stress, and bad sleeping habits are causing various problems during pregnancy.

The Role Of Nutrition And Exercise In Pregnancy

A good diet that provides all the necessary nutrition is another vital factor in pregnancy. The development of the baby relies completely on the nutrients provided by the mother in terms of iron, calcium, folic acid, protein, and vitamins.

Inadequate nutrition can cause various issues such as poor body weight, anemia, delays in the process of development, and premature delivery. Excessive intake of processed food, sugar-filled drinks, and junk food can cause the development of gestational diabetes, obesity, and high blood pressure in the course of pregnancy.

Exercise is also essential when it comes to sustaining a healthy pregnancy. Exercises such as walking, prenatal yoga, and stretching will aid women in improving their blood flow, managing their weight, reducing stress, and minimizing the chances of developing complications due to pregnancy.

However, it should be noted that pregnant women should not engage in rigorous exercise.

Why Managing Stress Is Key

Stress and mental health hold equal importance for pregnant women. Stressful situations may have a negative effect on the mother as well as the unborn child. Emotional stress, insomnia, anxiety, and occupational stress may result in hypertension, premature childbirth, and low birth weight.

Research indicates that prolonged maternal stress may even affect the neurodevelopment and behavior of the fetus. Thus, it becomes important to ensure the emotional stability of the pregnant woman through relaxation exercises and sufficient sleep.

The Importance of Sleep And Healthy Lifestyle Practices

Sleep is also an important yet underrated aspect that needs to be considered. Disrupted sleeping habits, working late into the night, and a lack of proper sleep may have adverse impacts on the hormonal balance of the body, thereby causing fatigue. Good sleep is essential for the body’s healing process, proper regulation of blood pressure, and the development of the fetus.

Some of the lifestyle practices may pose serious risks to the development of the fetus. The use of cigarettes, drinking alcoholic beverages, and drug abuse while being pregnant is linked to congenital anomalies, poor fetal growth, prematurity, and developmental problems. It should also be noted that secondhand smoke poses health risks to the baby.

A Healthy Pregnancy

Prenatal examinations are crucial in maintaining the well-being of the mother and fetus during the period of gestation. Early detection of possible problems through ultrasound, blood tests, immunization, and physician consultations can be achieved through regular prenatal examinations.

A healthy pregnancy does not merely involve avoiding diseases; it involves establishing an optimal environment for fetal growth and development. Healthy behaviors during pregnancy not only benefit the mother but also provide an excellent starting point for the health of her child in the future. With modern changes in lifestyle patterns, it is now more essential than ever before to be aware of and prevent any problems that might arise during pregnancy.