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

An analysis of health records from more than 1 million births found that the share of newborns whose parents refused the vitamin K shot rose by more than 57% during the first half of 2026. The rate increased from 5.2% to 8.1%, according to Reuters.

Vitamin K is a routine injection given to newborns within hours of birth. The number may sound like a small percentage but doctors are worried as vitamin K deficiency can cause sudden, potentially fatal bleeding in otherwise healthy babies, including bleeding inside the brain.

Why Do Newborns Need Vitamin K?

Newborns, however, are born very little vitamin K. Only small amounts cross the placenta during pregnancy, while the bacteria that help produce the vitamin have not yet become established in a newborn's intestine. Breast milk also contains very small amounts.

This leaves babies temporarily vulnerable to vitamin K deficiency bleeding, or VKDB. The standard vitamin K injection given after birth is meant to prevent that deficiency from becoming serious.

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What Happens If A Baby Does Not Get The Shot?

The most concerning part about VKDB is that parents may have no warning that something is wrong with the baby. Bleeding can occur internally, including in the intestines or brain. According to the CDC, around 30% to 60% of late VKDB cases involve bleeding inside the brain.

Late VKDB can occur from one week to six months after birth, often in babies who are born completely healthy. The CDC says newborns who do not receive the vitamin K shot are 81 times more likely to develop severe bleeding than babies who receive it.

Possible symptoms can include unusual sleepiness, irritability, seizures, vomiting, bruising or a bulging soft spot on the baby's head. But importantly, most cases have no warning signs before a life-threatening bleed occurs.

Also read: US Woman Gives Birth To Naturally Conceived Triplets Weighing Nearly 19 Pounds

Why Are More US Parents Refusing It?

Reuters' analysis found that refusals accelerated sharply this year. Pediatricians and public-health experts linked the trend to growing mistrust of medical interventions and misinformation, amid other changes in US public-health messaging.

The CDC has historically recommended a vitamin K injection at birth, with the practice dating back decades. Its guidance says the shot is the most reliable way to prevent VKDB.

Doctors Are Concerned About The Current Trend

The concern among pediatricians is that if refusal rates continue climbing, VKDB could stop being a rare neonatal emergency and start appearing more often in hospitals.

For a newborn who looks perfectly healthy, the risk can seem invisible and not so concerning. The problem is that the bleeding the vitamin K shot is meant to prevent can also be invisible until it becomes a medical emergency.

The UK today began the first phase of its flu vaccination program, offering jabs to millions of children and pregnant women ahead of winter.

Nearly 19 million people received their flu jab in England last year, helping prevent an estimated 104,000 hospitalizations.

Why Do Early Flu Vaccinations Matter?

Flu season typically peaks in December and January. Starting vaccinations earlier for children and pregnant women aims to protect those most vulnerable to serious illness and limit the spread of the virus before it circulates more widely.

Starting vaccination in September gives children and pregnant women time to build protection before flu begins circulating more widely. As per the NHS, the children’s flu vaccine can take up to 14 days to work.

Who Gets the Flu Jab First?

Children and pregnant women are among the first groups offered vaccination because they are more vulnerable to serious illness from flu.

Most school-aged children will receive their vaccine, via nasal spray, at school.

Parents of two- and three-year-olds, as well as children in clinical risk groups, will be invited to arrange vaccination through their GP practice.

Pregnant women can receive the flu jab at any stage of pregnancy through their maternity team, GP practice or participating pharmacy.

NHS teams are also taking vaccines into local communities, including through high street pharmacies and mobile vans.

Why Are Young Children and Pregnant Women More Vulnerable?

Flu can be much more serious than a bad cold. Every winter, thousands of children require hospital care because of the virus, while pregnant women also face a higher risk of serious illness.

Flu can spread quickly among younger age groups, which means vaccinating children can also help limit transmission to people who may be more vulnerable, including babies, grandparents and pregnant women.

Vaccinating pregnant women can also help protect their newborn babies in their first weeks.

“Flu can really knock you for six, and for some children and pregnant women it can mean becoming seriously ill or ending up in hospital. Getting vaccinated only takes a few minutes, but it can make a real difference – helping protect you and the people around you from getting seriously unwell,” said Dr Amanda Doyle, National Director for Primary Care and Community Services at NHS England.

When Will Other Groups Get Vaccinated?

From 1 October, flu vaccinations will be offered to other eligible groups, including:

• People aged 65 and over
• Adults with some long-term conditions
• Care home residents
• Carers
• Close contacts of people who are immunocompromised
• People experiencing homelessness
• Frontline health and social care workers

Parents of two- and three-year-olds will also be able to book appointments at participating community pharmacies through the National Booking Service from October.

NHS Expands RSV Vaccination Program

The NHS’s year-round RSV vaccination program is also expanding from today to include people aged 65 to 74 with a weakened immune system or certain long-term lung conditions.

RSV can make babies and adults with long-term lung conditions seriously unwell and increase their risk of hospitalisation.

Eligible people can receive the vaccine through their GP practice or, in some areas, a participating pharmacy. Those eligible should expect an invitation from their GP.

Pregnant women can also receive RSV, whooping cough and flu vaccines to help protect their newborn babies in their first weeks.

“Vaccinations play a vital role in protecting those most at risk from flu and they are also crucial for relieving pressures on our NHS over the winter months,” Secretary of State for Health and Social Care Yvette Cooper said.

“Everyone who is eligible for a free vaccination will be notified through their phone or in the post,” Cooper added.

A US woman has naturally conceived and given birth to a healthy set of triplets, a rare pregnancy that medical professionals described as an uncommon occurrence.

Nyla Craft from South Bay region in Los Angeles, already a mother of two — a daughter and a son — gave birth to three boys: two identical twins and a third who is their fraternal sibling, said chief of neonatology Dr Rohit Passi at Kaiser Permanente South Bay Medical Center, as reported by the Los Angeles Times.

“This is a very rare pregnancy and a rare outcome,” Passi said.

Triplets Conceived Naturally

The triplets were conceived naturally, Passi said, which happens in only about one in 10,000 pregnancies.

They were carried for 36 weeks, which is considered a good gestational period for triplets. All three were born at a healthy weight, with a combined weight of about 19 pounds — around three pounds short of the reported world record total weight for triplets, according to the Guinness Book of World Records.

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Pregnancy Was Physically Demanding

Craft said she first learned she was expecting triplets during a doctor’s appointment earlier this year.

“Earlier this year, I went to the doctor and I saw like two different sets,” she said. “I was like, oh my goodness, I’m having twins. And she was like, no, there are three. And I was like, oh my gosh, triplets.”

Craft said the physical demands of carrying the triplets were unlike anything she had experienced before.

When she learned the three babies weighed a combined 19 pounds at birth, the figure put her difficult pregnancy into perspective, ABC7.com reported.

Rare Combination Of Identical And Fraternal Twins

Quynh Vo-Hanser of Kaiser Permanente South Bay said the pregnancy was especially unusual.

“This is a really rare event,” Vo-Hanser said. “This is what we would refer to as a mixed triplet. This is a spontaneous pregnancy, which meant that it was achieved naturally. And within this triplet set, there’s an identical twin set, and then the fraternal sibling.”

Vo-Hanser emphasized the rarity of the birth. “Within the United States, there are 3.5 million deliveries and about 2,400 are triplets,” she said.

Hospital Assembled Larger Delivery Team

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The rare delivery on August 18 required a larger-than-usual medical team to care for both the mother and the three babies.

There were three NICU nurses, one for each baby, along with two doctors caring for the babies and additional doctors and nurses looking after Craft. “There were about 15 people in the delivery room when we normally have about five,” Passi said.

Triplets Came Close To Reported World Record

The trio’s combined birth weight of about 19 pounds also put them close to the reported world record for the heaviest set of triplets at birth, which stands at 22.7 pounds.

The combination of a naturally conceived triplet pregnancy, an identical twin pair and a fraternal sibling, all born at 36 weeks and of the same sex, made the delivery particularly unusual, according to the medical team.