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

Timely care during pregnancy, delivery, the newborn period and early childhood can help reduce some risks associated with cerebral palsy, a group of lifelong neurological disorders affecting movement, muscle tone and posture, experts said on the occasion of World Cerebral Palsy Day.

Observed annually on October 6, World Cerebral Palsy Day aims to raise awareness, advocate for equal rights and support the more than 50 million people living with cerebral palsy (CP) worldwide.

Speaking to HealthandMe, experts said preventing cerebral palsy may not always be possible, but appropriate care before and after birth and early recognition of developmental concerns can help reduce some risks and ensure timely support.

"While cerebral palsy cannot always be prevented, reducing avoidable risks around pregnancy and childbirth, recognizing complications such as reduced oxygen supply promptly, and providing appropriate newborn and developmental care can make a meaningful difference to a child’s health and functioning," Dr Neelam Suri, Senior Consultant, Obstetrics & Gynaecology, Indraprastha Apollo Hospital, Delhi, told HealthandMe.

Pregnancy and Birth: How Can The Risk Be Reduced?

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Dr Suri stressed the importance of regular antenatal care to identify and manage infections, high blood pressure, diabetes, fetal growth problems and other pregnancy complications.

Preventing or appropriately managing preterm birth is also important, as premature babies have a higher risk of developing cerebral palsy.

"One important concern around birth is birth asphyxia, where there is reduced oxygen supply to the baby’s brain, particularly during labor or delivery," Dr Suri said.

Timely recognition of fetal distress and appropriate intervention during childbirth can help reduce complications associated with reduced oxygen to the brain. Monitoring the baby during labor and having access to timely obstetric and newborn care are therefore important.

Dr Gurneet Singh Sawhney, Director, Stereotactic & Functional Neurosciences and Senior Consultant, Department of Neurosurgery & Spinal Surgery, Fortis Hospital, Mumbai, said the risk can also be lowered through regular antenatal check-ups, controlling diabetes and blood pressure, getting the rubella vaccine, treating infections promptly and avoiding smoking and alcohol.

"If a baby is likely to be born early, delivering at a well-equipped center makes a real difference. So does quickly treating newborn jaundice or breathing [problems]," he added.

After Birth: What Should Parents Watch For?

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Premature or medically vulnerable babies may need closer monitoring for breathing difficulties, infections, seizures and other problems that can affect the developing brain. Babies who experienced complications around birth may also require neurological and developmental follow-up.

Parents should pay attention to developmental milestones rather than waiting for delays to resolve on their own.

Early Warning Signs Parents Should Not Ignore

READ: World Meningitis Day: Why 1 In 3 Meningitis Deaths Occur In Children Under 5

"Parents are often told their child is just a late bloomer, but some signs need a doctor's attention," Dr Sawhney, told HealthandMe.

Parents should consult a doctor if their baby:

• Cannot hold up their head by four months

• Is not sitting by nine months

• Feels unusually stiff or floppy when picked up

• Favors one hand before the first birthday

• Has legs that cross like scissors

• Shows persistent toe-walking

Why Early Intervention Matters

"The first two to three years are when a child's developing brain adapts most easily. Starting physiotherapy, occupational therapy and speech therapy early helps children build healthy movement patterns. It also stops muscles from tightening into permanent contractures," Dr Sawhney said.

Regular hip and spine monitoring, bracing and, where needed, corrective surgery can also support mobility and independence.

"With regular hip and spine monitoring, bracing and, where needed, corrective surgery, many children go on to walk, play and attend school independently," he added.

The focus, experts said, should be on timely care from pregnancy through early childhood, with developmental concerns assessed as early as possible.

The World Health Organization (WHO) says meningitis still remains a major public health challenge, especially when it comes to children younger than five as they face the highest mortality.

Meningitis is inflammation of the membranes surrounding the brain and spinal cord. It can be caused by bacteria, viruses, fungi, and other pathogens. Bacterial meningitis is among the most severe forms which can lead serious complications and even death.

Meningitis is notorious for progressing at an alarming rate. Capable of deteriorating within hours, meningitis may not look the same in infants as it does in adults. Doctors explain why young children are vulnerable, the warning signs parents should not miss, and how vaccination can prevent some of the deadliest forms of the disease.

More than one-third of people who die from meningitis globally are children under five, according to recent estimates from the Global Burden of Disease Study 2023. In 2023, meningitis caused an estimated 259,000 deaths worldwide, with around 86,600 deaths occurring among children younger than five.

On World Meningitis Day, Healthandme looked at those figures to analyse what drives the likelihood of complications among children with the help of two experts - Dr. Praveen Gupta, Chairman - Marengo Asia International Institute for Neuro and Spine, Marengo Asia Hospitals, Gurugram and Dr. Prabhudev Hiremath, Consultant – Paediatric Neurology, Ramaiah Institute of Neurosciences, Ramaiah Memorial Hospital.

Children Under Five More Are Vulnerable To Meningitis

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Health experts stress that meningitis is not only preventable but also a medical emergency in which delays can have devastating consequences. According to Dr. Praveen Gupta, the developing immune system of young children is one of the key reasons why they are vulnerable to the infection.

He explained, "Children below five years of age and infants especially have a developing immune system that makes them susceptible to infections. There are different organisms that tend to be responsible depending on age groups. New-borns are prone to group B streptococcus, meningococcus, pneumococcus, and H.influenzae is a common cause among children."

Dr Prabhudev Hiremath explained that the vaccination gaps among infants make them more susceptible to complications. He also said that children may not present classic symptoms of meningitis as seen in adults. He added that the this difficulty in recognising meningitis in babies is particularly concerning because the disease can progress rapidly.

He said, "Their protective antibody levels are also lower, especially before the completion of the primary vaccination schedule. Certain bacteria can therefore enter the bloodstream and reach the coverings of the brain and spinal cord more easily. Meningitis in babies may not present with classical symptoms as we see in adults, which can delay recognition and treatment."

Meningitis Risk & Vaccination

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A significant proportion of bacterial meningitis is preventable by vaccination. WHO's global plan aims to reduce vaccine-preventable bacterial meningitis by 50% and deaths by 70% by 2030.

Vaccines targeting major bacterial causes, including pneumococcus, meningococcus and Haemophilus influenzae, have helped reduce meningitis in populations with high vaccination coverage.

Dr Gupta said, "A major portion of bacterial meningitis is vaccine-preventable, particularly for meningitis from H.influenzae type B (Hib), pneumococcus, and meningococcus. Though vaccination does not prevent all cases of meningitis, which is caused by viruses or other organisms, this method remains one of the best tools we have in order to prevent it."

He added, "Parents need to ensure that age-specific vaccinations are administered and discuss additional vaccines with their pediatrician depending on their child's risk. Pentavalent vaccine with Hib component and pneumococcal vaccination are included in the national immunization schedule of India."

Dr Hiremath also cautioned against assuming that vaccination eliminates all meningitis risk. He said, "Routine childhood immunization has dramatically reduced meningitis in countries with high vaccine coverage. However, vaccination cannot prevent every form of meningitis, so parents should not dismiss concerning symptoms simply because a child is fully vaccinated."

Meningitis Symptoms In Babies

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One of the biggest challenges for parents is that an infant cannot say that they have a severe headache or a stiff neck. This means parents need to watch for changes in feeding, behaviour, alertness and crying, rather than waiting for the classic symptoms seen in adults.

Dr Gupta said, "Do not wait for the symptoms of headache with neck stiffness in babies. Look out for high fever, unusual drowsiness or lethargy, irritability, continuous or unusual crying, poor feeding, repeated vomiting, convulsions, unusual behavior, or bulging fontanelle. Older children may present with fever, severe headaches, vomiting, neck stiffness, photophobia, confusion, and increased lethargy."

Meningitis Can Become Life-Threatening Within Hours

Bacterial meningitis is a medical emergency. WHO notes that clinical deterioration can be rapid, with death potentially occurring within 24 hours without prompt treatment. Dr Gupta stressed how quickly a child's condition can change. He said that bacterial meningitis and meningococcal infection deteriorate very fast, progressing from flu-like symptoms to severe illness within hours.

He explained, "When a child presents with fever with altered behavior, extreme lethargy, convulsions, breathing difficulties, persistent vomiting, severe headaches, neck stiffness, cold hands and feet, or a rapidly developing dark or purplish rash, parents should never opt for a wait-and-watch approach. If you suspect meningitis, every minute counts. It's an emergency."

Dr Hiremath explains how a peculiar meningitis-related rash can appear, which is considered to be a major warning sign.

He said, "A non-blanching, purple or reddish rash is another major warning sign, particularly with meningococcal infection. Parents should not wait for every classical symptom to appear.

Treatment Does Not Signify A Child Has Fully Recovered

The doctors caution against assuming that after an infection is treated, the child recovers completely. WHO estimates that about one in five people affected by bacterial meningitis develop long-term complications, which can include neurological and sensory disabilities.

For children, these complications may become more apparent only as they grow and developmental or academic demands increase.

Dr Gupta said, "About one-fifth of people who have experienced the disease end up having some kind of complication. The complications may range from hearing loss, seizures, weakness and neurological issues, and intellectual disabilities. Children will have to be observed for possible speech and language problems, cognitive and learning disabilities, memory, attention, behavioral and developmental delays."

Dr Hiremath stressed that some problems may not be immediately obvious after discharge.

He said, "Not all these complications are obvious when a child leaves the hospital. Some may become apparent months later, particularly as developmental and academic demands increase. That is why regular follow-up is important after meningitis."

Dr. Gupta lists necessary tests and evaluations that must children exposed to meningitis should undergo to get timely treatment and necessary care.

"Hearing tests, neurological assessment, developmental or cognitive evaluation need to be done based on the disease and recovery. Early intervention and proper education may prove to be very important. WHO particularly emphasizes care, support and aftercare of those who have been through meningitis as a part of its 2030 strategy," explains Dr. Gupta.

The 2023 analysis estimated 259,000 meningitis deaths worldwide. Children under five accounted for more than one-third of them. Doctors urge that vaccination remains one of the strongest tools for preventing serious bacterial meningitis, but recognising symptoms early remains crucial.

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.