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

Eye specialists worldwide are raising the alarm, as myopia, or nearsightedness, is on the rise among children at a rate that is making eye doctors and pediatricians reconsider how they assess young patients.

What used to be a mild inconvenience that could be corrected with a pair of glasses is now being treated as a long-term health concern. High myopia in childhood is associated with an increased risk of serious eye conditions later in life, including retinal detachment, glaucoma and myopic macular degeneration. This is not just an anecdotal change.

Public health professionals say the development is likely due to a variety of causes, including more time spent on screens, less time outdoors, and more strenuous academics, which most online work is entangled with. The good news is that myopia can be controlled if it is discovered early.

Optometrists have an expanding toolbox of options, including customized contact lenses, Ayurvedic eye drops, and more time spent outdoors, that can help to delay its advancement in children. The trick is to catch it early. Seven warning flags to look out for as a parent

1. Squinting To See Distant Objects

Because myopia often develops gradually, many parents don't realize their child is struggling to see clearly until a school vision screening flags it or until the child is already several dioptres into nearsightedness.

A child who consistently squints to read the whiteboard, to watch TV from across the room, or to notice a buddy coming towards them is usually making an instinctive attempt to make a murky image clearer. Squinting alters the shape of the eye's opening for a brief period, which can help bring things that are far away into marginally better focus — but it's a signal, not a solution.

2. Sitting Too Close To TV Or Screens

A child who always sits inches from the screen, holds tablets or books very near to their face, or asks for a front-row seat at school may be compensating for trouble seeing things far away.

Also read: El Salvador Becomes First Country In Central America To Eliminate Trachoma: WHO

3. Regular Headaches Or Eye Strain

Children who have difficulty focusing on things that are far away have eyes to work harder all day. This added stress may manifest as frequent headaches, especially after school, screen time, or reading.

4. Poor Performance In School or Attention

Kids don’t usually say, “I can’t see the board. Instead, a sudden dip in grades, difficulties reproducing notes or seeming distracted and uninterested in class can be an ignored symptom of undetected vision problems.

5. Holding Books Or Devices Unusually Close

Similar to sitting close to screens, a child who holds a book, tablet, or phone very near their face may be doing so instinctively to bring text into focus.

6. Rubbing Eyes Frequently Or Excessive Blinking

While rubbing eyes and blinking can have many causes, when paired with other signs on this list, they can indicate visual fatigue from the eyes constantly trying to compensate for blur.

Also read: Tadalafil: Common Male-Potency Drug May Raise Glaucoma Risk In Men, Finds Study

7. Complaints That Things "Look Fuzzy" From A Distance

Sometimes the sign is simply the child telling you directly — that the street signs look blurry, that they can't see the ball until it's close, or that faces "look fuzzy" from across the room.

These direct complaints are often the clearest signs that your child is experiencing visibility issues. While rubbing eyes and blinking can have many causes, when paired with other signs on this list, they can indicate visual fatigue from the eyes constantly trying to compensate for blur.

Why Early Detection Matters

Pediatric eye specialists usually advocate regular vision examinations beginning in early childhood and continuing through the school years, as this is the age when myopia most typically first develops and progresses the fastest — between 6 and 12 years of age. If any of the following indicators are noticed, parents are recommended to schedule a full eye exam with an optometrist or eye specialist rather than waiting for the next standard school screening.

Common lifestyle adjustments include more unstructured outdoor time, regular breaks during near-work tasks (following the general “20-20-20” guideline of looking at something 20 feet away for 20 seconds every 20 minutes), and proper lighting for reading and homework, alongside professional treatment options.

By Dr Mandeep Singh Basu, Ayurvedic Eye Specialist, Dr Basu Eye Care Centre

The recent Lindsay Clancy case has renewed public discussion around postpartum mental health, particularly postpartum psychosis—a rare but severe psychiatric condition that can develop after childbirth. Experts say it is important to distinguish postpartum psychosis from the intrusive thoughts that many new mothers experience, as the two are fundamentally different.

Postpartum psychosis is considered a medical emergency that requires immediate psychiatric care. While the condition is rare, early recognition by family members and prompt treatment can significantly improve recovery.

What Is the Case About?

Lindsay Clancy, a labour and delivery nurse at Massachusetts General Hospital, is accused of killing her three children—Cora, 5, Dawson, 3, and eight-month-old Callan—at the family's home in Duxbury, Massachusetts, on January 24, 2023. Prosecutors allege she strangled them with exercise bands before attempting to take her own life by jumping from a second-floor window. Her husband, Patrick Clancy, discovered the scene after returning home.

Clancy has pleaded not guilty. Her defence argues she was suffering from severe postpartum psychosis and undiagnosed bipolar disorder, making her not criminally responsible. Prosecutors contend she "knew exactly what she was doing."

In the weeks before the deaths, Clancy wrote in her journal, "I want help. I want to be well," and had sought treatment through a postpartum depression program.

HealthandMe spoke to two health experts to understand postpartum psychosis, how it differs from intrusive thoughts, and the warning signs families should know.

What Is Postpartum Psychosis?

Dr. Shiv Prasad, Professor and Head of the Department of Psychiatry at Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, New Delhi, explained that postpartum psychosis is a rare but severe mental illness that usually occurs within the first two weeks after delivery.

"It is considered a psychiatric emergency because the mother may lose touch with reality and may not be able to make safe decisions for herself or her baby," he told HealthandMe. Postpartum psychosis affects around 1 in 1,000 mothers after childbirth and is a psychiatric emergency.

Postpartum Psychosis Is Different From Intrusive Thoughts

Many women experience intrusive thoughts after childbirth, but experts stress these should not be confused with postpartum psychosis.

"While many new mothers experience intrusive thoughts, distressing, unwanted thoughts that they recognize as irrational and are unlikely to act upon, postpartum psychosis is fundamentally different. It involves a loss of touch with reality, with symptoms such as delusions, hallucinations, extreme confusion, severe mood changes, and disorganized behavior," Dr. Sabine Kapasi, a gynecologist, Global Health Strategist, and a UN Advisor, told HealthandMe.

While intrusive thoughts are relatively common, especially in women with anxiety or obsessive-compulsive disorder (OCD), women with postpartum psychosis may experience hallucinations, delusions, confusion, or believe they must act on false beliefs.

"The biggest difference is that women with intrusive thoughts usually know the thoughts are irrational, while women with postpartum psychosis often believe their experiences are real," Dr. Prasad said.

Experts said postpartum psychosis is treatable and that most women recover well with timely diagnosis, psychiatric care, medication and family support.

Warning Signs Families Should Never Ignore

The experts said family members are often the first to notice changes in a new mother's behavior. According to Dr. Kapasi, sudden personality changes, unusual beliefs, insomnia without feeling tired, paranoia, and hearing or seeing things that others do not are major warning signs that require immediate medical attention.

"Early identification of these red flags by families is very important. Sudden personality shifts, strange beliefs, insomnia without fatigue, paranoia, or hearing and seeing things that others do not require prompt medical attention."

Dr. Prasad said these symptoms should never be dismissed as normal postpartum stress.

"Families are often the first to notice that something is seriously wrong. Warning signs may include sleeplessness, sudden confusion, unusual behavior, hearing or seeing things that others cannot, expressing strange beliefs, or talking in a way that doesn't make sense."

He advised that if these symptoms appear, the mother should not be left alone with the baby until she has been assessed by a doctor, and urgent psychiatric help should be sought.

The experts stressed that postpartum psychosis is not a sign of weakness or poor parenting, but a medical emergency that requires compassion, immediate treatment and family support.

The Lindsay Clancy trial is ongoing. If convicted of murder, she faces life in prison without parole. If found not guilty by reason of lack of criminal responsibility, she would be committed to a state mental health facility, according to the Associated Press.

The monsoon brings welcome relief from the heat, but it also creates the perfect environment for viruses, bacteria, fungi, and mosquitoes to thrive. As a result, babies become more vulnerable to infections such as coughs and colds, diarrhoea, skin rashes, fungal infections, and mosquito-borne illnesses like dengue and malaria.

Since an infant’s immune system is still developing, they require extra care during the rainy season. Fortunately, many monsoon-related illnesses can be prevented by avoiding a few common mistakes.

Not Changing Damp Clothes Promptly

Leaving babies in damp clothes for long periods can cause discomfort, heat rash, skin irritation, and fungal infections, especially in skin folds. Whether clothes become wet from rain, sweat, or spills, they should be changed immediately. Dress your baby in soft, clean, breathable cotton clothing.

Neglecting Hand Hygiene

Hand hygiene is one of the simplest and most effective ways to prevent infections. Parents and caregivers should wash their hands with soap and water before touching or feeding the baby and after returning home. Anyone with symptoms such as cough, cold, fever, vomiting, or diarrhoea should avoid close contact with infants.

Also read: Breastfeeding Can Help Reduce Mothers' Risk of Type 2 Diabetes, Breast Cancer and More

Giving Stale or Improperly Stored Food

If your baby has started complementary feeding, always offer freshly prepared home-cooked meals. During humid weather, bacteria multiply rapidly in improperly stored food, increasing the risk of stomach infections. Avoid feeding leftovers that have been kept at room temperature for long periods.

Ignoring Mosquito Protection

The rainy season is associated with a rise in mosquito-borne diseases such as dengue and malaria. Use mosquito nets, eliminate stagnant water around your home, and dress your baby in light, full-sleeved clothing. Avoid applying mosquito repellents directly to infants younger than two months unless specifically recommended by your paediatrician.

Also read: Study Links Excessive Screen Time To Poorer Body Image in Teens With Skin Conditions

Keeping the Home Damp and Poorly Ventilated

Damp surroundings encourage mould and fungal growth, which can trigger allergies and respiratory problems. Keep your home well-ventilated, dry wet areas promptly, and ensure that your baby’s bedding, blankets, mattresses, and soft toys are completely clean and dry before use.

Overdressing Your Baby

Many parents assume babies need extra layers during the monsoon. In reality, overdressing can lead to overheating, excessive sweating, and skin rashes. Dress your baby according to the indoor room temperature rather than the weather outside. To assess whether your baby is comfortable, feel the neck or chest instead of the hands or feet, which are naturally cooler.

Also read: Should Children Take Protein Powders? A Dietitian’s Perspective

Trying Home Remedies Without Medical Advice

Avoid steam inhalation, balms, herbal oils, over-the-counter cold medicines, or traditional remedies unless advised by your paediatrician. Honey should never be given to babies under one year of age because of the risk of infant botulism. Always seek medical advice before giving any medication or home remedy.

Taking Young Babies to Crowded Places Unnecessarily

Crowded indoor spaces such as shopping malls, family gatherings, and social events increase the risk of viral infections. Limiting unnecessary exposure, especially during the first few months of life, can significantly reduce the chances of your baby falling ill.

A baby’s first monsoon can be a worrying time for new parents, but a few simple precautions can go a long way in keeping your little one healthy and comfortable. Good hygiene, fresh food, mosquito protection, a clean and dry environment, and timely medical advice are the keys to preventing most monsoon-related illnesses.

If your baby develops persistent fever, breathing difficulty, poor feeding, repeated vomiting, diarrhoea, decreased activity, or signs of dehydration, seek medical attention without delay.