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

India’s Union Ministry of Health and Family Welfare has issued a notification ending the over-the-counter (OTC) sale of all syrups, including cough syrups.

Under the new rules, a doctor's prescription will now be required to purchase cough syrups across the country.

“Consequently, the sale and dispensing of cough syrups in smaller villages will now be required to take place only through duly licensed pharmacies in accordance with the provisions of the Drugs and Cosmetics Act, 1940 and the Rules framed thereunder,” the notification said.

Why Are the Rules Being Amended?

The amendment comes months after contaminated cough syrups were linked to the deaths of 22 children in Madhya Pradesh and Rajasthan, raising fresh concerns over the safety and regulation of commonly used liquid medicines.

Following the incident last year, health authorities in India had banned three cough syrups Coldrif, Respifresh TR and ReLife after traces of diethylene glycol (DEG) were detected in the products. The Coldrif contamination was linked to the deaths of 22 children in the country.

“The amendment has been undertaken to strengthen regulatory oversight of syrup formulations and to align the exemption framework with contemporary public health and safety requirements,” the notification said.

“The measure is expected to promote responsible distribution and sale of cough syrups while ensuring greater compliance with regulatory standards across the country,” it added.

Also read: Introducing Eggs Before Age One May Lower Allergy Risk by 17%, Says Study

Experts Welcome Move To Restrict Cough Syrup Sales

Dr Kuldeep Kumar Grover, Associate Director, Pulmonology and Critical Care, CK Birla Hospital, Gurugram called it a

"a good initiative to include all syrup varieties, cough syrups included, under prescription medicines".

Cough syrups have substances that might lead to drowsiness, addiction, or drug interaction in patients who do not seek medical advice before taking the medicines.

"It is important to note that a cough could be a symptom of other serious conditions like infections, asthma, and allergies. Prescription-based access encourages proper evaluation, accurate treatment, and safer medication use," Grover said.

Dr. (Prof.) Mohsin Wali, former Physician to the President of India, said cough syrups and similar formulations often contain suppressants such as codeine and dextromethorphan (DXM), along with other solvents.

Dr. Wali, Senior Consultant and Head of Preventive Cardiology at Pacific One Health, recalled previous incidents in which contaminated Indian-made cough syrups were linked to deaths in Gambia and other African countries.

"Industrial-grade solvents were detected in some of these products, leading to kidney failure, severe metabolic acidosis, and, in some cases, death," he said.

According to Dr. Wali, the new notification will help curb the overuse, misuse, and addictive use of cough syrups while improving patient safety.

What Did The Notification Say?

The Ministry notified an amendment to the Drugs Rules, 1945, through Gazette Notification G.S.R. 927(E) dated December 29, 2025, published in the Gazette of India Extraordinary, Part II, Section 3, Sub-section (i), dated December 30, 2025.

The amendment omits the word “Syrup” from Schedule K, Serial No. 13, Entry 7 under the heading “Class of Drugs.”

Schedule K of the Drugs Rules, 1945, provides exemptions from certain provisions of the Drugs and Cosmetics Act, 1940, and the rules framed under it for specified classes of drugs.

Before this amendment, Entry No. 13 of Schedule K permitted the sale of cough syrups in villages with a population of less than 1,000 without requiring compliance with certain retail sale licensing provisions.

With the omission of the word “Syrup” from the entry, this exemption will no longer apply to cough syrups.

Manufacturers, distributors, and retailers dealing with cough syrups have been advised to ensure strict compliance with the applicable licensing and regulatory requirements under the Drugs and Cosmetics Act, 1940, and the Drugs Rules, 1945.

Ban On Pediatric Cough Syrups

Last year, India formally prohibited the use of certain commonly available OTC cough and cold medicines in children below the age of four.

The policy move, notified through a gazette notification, banned a fixed-dose combination (FDC) of Chlorpheniramine Maleate and Phenylephrine Hydrochloride—two ingredients commonly found in pediatric cough syrups.

The decision followed growing global concerns over the safety of these medicines in very young children, with India joining several countries that have introduced stricter regulations.

Countries including the United States, Canada, and the United Kingdom had previously issued guidelines or warnings regarding the use of OTC cough and cold medicines in young children.

A new botulism outbreak in the United States linked to the now-recalled Nara Organics Whole Milk Organic powdered infant formula has led to hospitalization of at least three infants in three states, according to a notice from the Centers for Disease Control and Prevention (CDC).

The affected infants, aged between 2 and 5 months, are from California, Pennsylvania, and Washington state. All three have been hospitalized and are receiving treatment for infection caused by the bacterium Clostridium botulinum.

The CDC noted that on June 13, Nara Organics recalled all Nara Organics Whole Milk Organic Infant Formula products, including all lot numbers and both can sizes. The products were sold online and at major retailers nationwide.

“Testing of opened cans of Nara Organics brand formula and unopened Nara Organics product samples is underway, and results are expected in the coming weeks,” the CDC said.

This is the second recent outbreak of infant botulism linked to powdered formula. Earlier this year, investigators from the California Department of Public Health, working with federal officials and other state health departments, identified 51 suspected or confirmed cases of infant botulism across 19 states between March 2022 and December 2025. Those infants had consumed ByHeart infant formula.

What Parents And Caregivers Should Do

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The CDC has urged parents and caregivers to immediately stop using any Nara Organics Whole Milk Organic Infant Formula.

If you have unopened cans of the recalled formula, throw them away or return them. Parents should also wash any items and surfaces that may have come into contact with the formula with hot, soapy water or in the dishwasher.

Seek immediate medical attention if your infant consumed the recalled formula and develops any of the following symptoms:

• Poor feeding
• Loss of head control
• Difficulty swallowing
• Decreased facial expression

Symptoms of infant botulism can take several weeks to appear. Parents whose infants consumed the recalled formula should monitor them for symptoms for up to one month after their last exposure.

What Is Botulism?

Read More: Introducing Eggs Before Age One May Lower Allergy Risk by 17%: Study

Botulism is a rare but serious illness caused by a toxin produced by the bacterium Clostridium botulinum. The toxin attacks the nervous system and can lead to life-threatening complications if not treated promptly.

Botulism is considered a medical emergency because it can cause paralysis and breathing difficulties.

Types of Botulism

There are several forms of botulism, including:

• Foodborne botulism
• Wound botulism
• Iatrogenic botulism
• Inhalation botulism
• Infant botulism

Infant botulism is the most common form in babies between 2 and 8 months old. It occurs when Clostridium botulinum spores grow in a baby's intestines and produce toxin. Honey and contaminated soil are known sources of exposure.

Symptoms of Infant Botulism

Symptoms typically begin 18 to 36 hours after exposure and may include:

• Constipation is often the first sign
• Weak or floppy movements
• Weak cry
• Drooling
• Drooping eyelids
• Difficulty feeding or sucking
• Progressive paralysis

Infant botulism often begins with constipation but is usually first recognized through feeding difficulties, a weak or altered cry, and poor head control.

If left untreated, the illness can progress to severe paralysis, breathing difficulties, and prolonged hospitalization.

Egg freezing, once perceived as a concept limited to celebrities or affluent urban populations, is gradually becoming an important part of reproductive planning among Indian women, according to fertility experts.

Dr. Tarang Yadav, Senior Consultant - IVF, Obstetrics and Gynecology, ShardaCare–Healthcity, told HealthandMe that India is witnessing a gradual shift in conversations surrounding reproductive health, with more women seeking fertility consultations proactively rather than after experiencing difficulty conceiving. As per the expert, this trend is particularly visible in metropolitan and tier-2 cities.

The reason? Increasing awareness regarding fertility, delayed parenthood, evolving lifestyles, and advancements in reproductive medicine have contributed to growing interest in fertility preservation across different age groups and professional backgrounds.

"Today, more women are prioritizing education, career growth, financial stability, and personal readiness before planning pregnancy," Dr. Tarang said.

According to the World Health Organization, around 17.5 per cent of the adult population globally, nearly 1 in 6 people, experience infertility at some point in their lives, highlighting the growing need for accessible fertility care and awareness.

Also read: High Prolactin Levels Behind 40% Surge In Female Infertility Cases, Warn Doctors

What Is Egg Freezing?

Dr. Tarang explained that egg freezing, medically known as oocyte cryopreservation, allows women to preserve healthier eggs at a younger reproductive age, potentially improving future reproductive opportunities. While it does not guarantee pregnancy later in life, it offers an additional reproductive option for women who may wish to delay childbearing for personal, social, or medical reasons.

According to current international fertility preservation guidelines, planned oocyte cryopreservation can be considered in appropriately counselled women, particularly when undertaken at a younger age and after proper fertility assessment.

Who May Benefit From Egg Freezing?

Dr. Tarang noted that egg freezing is increasingly being considered not only for social reasons but also for several medical indications.

Women who can benefit from fertility preservation include those:

• planning a delayed pregnancy due to career or personal circumstances, who have not yet found a suitable life partner,
• cancer patients undergoing chemotherapy or radiotherapy, women with severe endometriosis, patients undergoing ovarian surgeries,
• with diminished ovarian reserve
• with a family history of premature ovarian insufficiency

"In such situations, fertility preservation can provide psychological reassurance and reproductive flexibility before ovarian function declines further," Dr. Tarang said.

Read More: India Makes Significant Progress In Maternal Care, Nutrition And Child Immunization: NFHS-6

Why Timing Matters

Although egg freezing can be considered at different ages depending on individual ovarian reserve and reproductive goals, outcomes are generally better when eggs are frozen before the age of 35. Younger eggs tend to have better quality and chromosomal competence, which may improve future IVF outcomes.

The expert stressed the importance of early fertility counselling and ovarian reserve assessment. Tests such as Anti-Müllerian Hormone (AMH), ultrasound-based antral follicle count (AFC), and overall reproductive evaluation help determine whether a woman is an appropriate candidate for egg freezing.

Common Concerns About Egg Freezing

Addressing common concerns around the procedure, Dr. Shanujeet Kaur, Associate Director and Senior Gynecologist, Department of Fertility and Gynecology at Cloudnine Group of Hospitals, Chandigarh, told HealthandMe that some women may experience temporary mood swings due to hormonal medications used during ovarian stimulation.

Light to moderate exercise, including walking and stretching, is generally safe during treatment, though high-intensity workouts may be discouraged as the ovaries enlarge.

Current research suggests egg freezing is generally safe, with no strong evidence linking fertility medications used during the procedure to long-term health problems such as breast cancer, ovarian cancer, or infertility in most women.

Recovery after egg retrieval is typically quick, with most women able to resume normal activities within one to three days, though mild cramping, bloating, spotting, or fatigue may occur temporarily.

The expert also advised maintaining a balanced diet, staying hydrated, and following personalised medical guidance regarding birth control and lifestyle measures during treatment.