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

For new parents, few decisions feel as important as choosing how to feed their newborn. While breastfeeding is widely recognized as the best source of nutrition for infants, not every family can follow the same path. The key is to ensure that every baby receives adequate nutrition, care, and love, whether through breast milk or infant formula.

Health experts, including the World Health Organization (WHO) and the Indian Academy of Pediatrics (IAP), recommend exclusive breastfeeding for the first six months of life whenever possible. This recommendation is based on decades of scientific evidence showing that breast milk offers benefits that extend far beyond nutrition.

Breastfeeding Is The Gold Standard

Unlike any other food, breast milk is a dynamic, living substance. It contains the right balance of proteins, fats, carbohydrates, vitamins, and minerals that an infant needs, while also delivering antibodies, enzymes, and immune cells that help protect against infections. These natural protective factors play a crucial role during the early months when a baby’s immune system is still developing.

One of breast milk’s most remarkable qualities is its ability to adapt. The first milk, known as colostrum, is especially rich in antibodies and acts as a baby’s first natural vaccine. As weeks and months pass, the composition of breast milk changes to match the infant’s evolving nutritional requirements. This ability to respond to a baby’s changing needs cannot be replicated by formula.

The benefits of breastfeeding are reflected in both short- and long-term health outcomes. Babies who are exclusively breastfed are less likely to suffer from diarrhoea, respiratory infections, ear infections, and several digestive illnesses. Breastfeeding also supports the development of a healthy gut microbiome, which contributes to stronger immunity. Studies further suggest that breastfeeding may reduce the risk of obesity, type 2 diabetes, and certain allergic conditions later in childhood.

The advantages are not limited to babies alone. Breastfeeding supports a mother’s recovery after childbirth by helping the uterus return to its normal size and reducing postpartum bleeding. It also strengthens the emotional bond between mother and baby through close physical contact. In the long term, breastfeeding has been associated with a lower risk of breast cancer, ovarian cancer, and osteoporosis.

When Is Formula Feeding A Necessary Alternative?

That said, breastfeeding is not always possible. Medical conditions, certain medications, low milk production, maternal illness, work commitments, or mental health challenges can make breastfeeding difficult. In such situations, parents should never feel that they have failed.

Modern infant formulas are carefully developed to provide complete nutrition for infants who cannot be breastfed. When prepared correctly, the formula supports healthy growth and development and remains a safe, dependable alternative. Parents should always seek guidance from their paediatrician to choose the most appropriate feeding option for their baby.

Healthy Infant Feeding Without Judgment

It is equally important to remember that healthy feeding is more than what goes into the bottle or breast. The way a baby is fed matters, too. Holding the baby close, maintaining eye contact, responding to hunger cues, and creating a calm, nurturing feeding environment all contribute to emotional security and healthy development.

There is no one-size-fits-all approach to infant feeding. Every mother and every baby has unique circumstances, and feeding decisions should be based on medical advice rather than social pressure or comparison.

Breast milk remains the gold standard because of its unmatched nutritional and immune-protective properties. However, when breastfeeding is not possible, infant formula provides a safe and effective alternative that allows babies to thrive.

Ultimately, what matters most is not how a baby is fed, but that every child is nourished, loved, and given the healthiest possible start in life.

By Dr. Sanjay Majmudar, Consultant Paediatrician, Bhailal Amin General Hospital, Vadodara

The journey of pregnancy is a biological marathon, demanding precise nutritional orchestration to support the developing fetus while maintaining maternal physiological homeostasis. Among the pantheon of essential micronutrients, vitamin E often occupies a quieter corner compared to the high-profile roles of folic acid or iron.

However, for the expectant mother and the newborn's burgeoning health, vitamin E is a critical antioxidant, a shield against oxidative stress, and a vital participant in preventing neonatal complications such as infantile jaundice.

Understanding Vitamin E: The Fat-Soluble Guardian

Vitamin E is not a single compound but a family of eight fat-soluble antioxidants—tocopherols and tocotrienols. Because it is fat-soluble, its absorption is intrinsically linked to the presence of dietary fats and proteins in the maternal diet. During pregnancy, the body undergoes significant metabolic shifts, and vitamin E serves as a potent defender against reactive oxygen species (ROS), which can threaten both placental integrity and fetal development.

Like every nutrient, vitamin E has values for recommended dietary allowances (RDA), adequate intake (AI), tolerable upper limits (UL), and toxicity dosage (TD), so one must be cautious while self-indulging in food sources, supplements, or food formula intake. The form of vitamin E, the source, and the adequacy of intake influence the biological outcomes.

As noted by a nutritional biochemist, "Vitamin E acts as the cellular gatekeeper. By stabilizing membranes against lipid peroxidation, it ensures that the physical architecture of both maternal tissues and the developing fetal brain remains resilient under the metabolic stress of gestation."

Vitamin E And Clinical Health

Vitamin E deficiency is infrequent, with overt symptoms typically absent in healthy individuals consuming low amounts. However, premature infants weighing less than 1,500 grams may experience deficiencies, which can lead to complications unless supplemented, albeit with an increased risk of infections. Individuals with fat malabsorption disorders, such as Crohn’s disease or cystic fibrosis, are more susceptible to deficiency because vitamin E requires fat for absorption.

Symptoms of deficiency include peripheral neuropathy, ataxia, skeletal myopathy, retinopathy, and immune response impairment. Rare cases, such as abetalipoproteinemia, necessitate high doses of supplemental vitamin E for proper absorption due to severe deficiencies linked to nerve damage and retinal degeneration.

Another similar condition, Ataxia with Vitamin E Deficiency (AVED), results from a defective alpha-tocopherol transfer protein, leading to significant deficiency and associated nerve damage, requiring substantial supplemental vitamin E to avoid loss of mobility.

Excess Intake And Harmful Effects

Research indicates that consuming vitamin E through food poses no adverse effects; however, high doses of alpha-tocopherol supplements can lead to hemorrhage and disrupt blood coagulation. In vitro studies suggest that elevated doses inhibit platelet aggregation. Notably, many in the latter trial were also using aspirin, raising concerns about vitamin E's propensity to cause bleeding.

The Food and Nutrition Board (FNB) has set Upper Limits (ULs) for vitamin E due to these potential hemorrhagic effects, applicable to all supplementary forms of alpha-tocopherol, including its eight stereoisomers in synthetic vitamin E. Doses up to 1,000 mg/day (1,500 IU for natural form or 1,100 IU for synthetic) appear safe, yet the evidence primarily stems from small participant groups taking up to 3,200 mg/day only for short durations. Long-term consumption exceeding the UL increases the risk of adverse health outcomes, with ULs for infants yet to be determined.

Maternal Diet And The Synthesis Of Health

A well-rounded maternal diet is the foundation for a successful pregnancy. Because vitamin E is fat-soluble, its bioavailability is optimized when consumed alongside healthy fats and high-quality proteins. Proteins serve as the transport vehicles for these nutrients, while fats facilitate the bile-assisted absorption process in the small intestine.

Almonds As A Source Of Fat-Soluble Vitamin E

One of the most efficient and nutrient-dense ways to ensure adequate vitamin E intake during pregnancy is through the inclusion of nuts, specifically almonds. Almonds represent a "superfood" synergy: they provide a robust concentration of alpha-tocopherol (the most biologically active form of Vitamin E) nestled within a matrix of heart-healthy monounsaturated fats and plant-based proteins.

For the expectant mother, snacking on almonds provides a dual benefit. The fat content aids in the absorption of vitamin E, while the protein profile contributes to the amino acid pool necessary for fetal organogenesis. By integrating almonds into a mid-morning snack or a yogurt topping, women can achieve a steady serum level of this vital antioxidant throughout the day.

Roasted almonds are the best bet when compared to soaked almonds, as soaked almonds absorb more moisture and reduce the bioavailability of vitamin E.

Vitamin E And The Prevention Of Infantile Jaundice

Infantile jaundice, a condition characterized by the yellowish discoloration of the skin and eyes, is one of the most common clinical scenarios in neonatology. It arises from hyperbilirubinemia, where the breakdown of red blood cells results in an accumulation of bilirubin that the infant’s immature liver cannot yet efficiently process.

The link between vitamin E and jaundice is rooted in its ability to protect red blood cell membranes. During the late stages of pregnancy, vitamin E stores are transferred from the mother to the fetus. If maternal levels are insufficient, the foetal red blood cells may be more susceptible to oxidative damage. When these fragile cells break down prematurely after birth, they flood the infant’s system with excessive bilirubin.

By maintaining optimal vitamin E levels, the mother supports the structural integrity of fetal erythrocytes. While vitamin E is not a cure for all forms of neonatal jaundice, its role as a membrane protector is a fundamental preventative measure in promoting neonatal metabolic stability.

Key Nutrients For Maternal And Neonatal Support

Effective dietary planning during pregnancy requires a balance of micronutrients. An average of 15mg-20mg of vitamin E is required per day during pregnancy.

The Clinical Perspective: Why Supplements Aren't Always Enough

While the temptation to reach for a prenatal supplement is common, clinicians emphasize that whole-food sources provide superior bioavailability. The matrix of an almond contains fiber, polyphenols, and minerals, which creates a "nutritional choir" that is far more effective than isolated tocopherol supplements.

As one of the renowned obstetricians asserts, "Nutrition during pregnancy is not about isolated bullets; it is about the landscape of intake. When a mother consumes Vitamin E through nuts, seeds, and healthy oils, she is providing her baby with a complex biological support system that a synthetic pill simply cannot replicate."

Vitamin E And Drug Interactions

Mothers who are on anticoagulant and antiplatelet medications must be cautious, as they may interact with vitamin E, which can inhibit platelet aggregation and antagonize clotting factors, potentially increasing bleeding risk, particularly when intake of vitamin K is low. Additionally, vitamin E combined with antioxidants like vitamin C and niacin can blunt increases in cardioprotective HDL cholesterol when taken with simvastatin.

Dietary Strategies for the Expectant Mother

To maximize the benefits of Vitamin E, expectant mothers should consider the following dietary adjustments:

1. Prioritize Healthy Fats: Incorporate avocados, groundnut oil, ghee, and nuts into everyday meals to ensure the fat-soluble Vitamin E is absorbed by the digestive tract.

2. Combine with Protein: Pairing Vitamin E-rich foods like sunflower seeds or almonds containing protein helps maintain tissue growth, blood volume, and ensures efficient nutrient utilization.

3. Consistency Over Intensity: Because Vitamin E is stored in body fat, a consistent, moderate intake is more effective than intermittent high-dose supplementation, which may lead to toxicity.

Conclusion

The complexity of pregnancy requires a proactive approach to nutrition that extends beyond caloric intake. Vitamin E, as a guardian of cellular integrity, plays an understated yet essential role in protecting the mother from oxidative stress and safeguarding the newborn from the hematological instability that often leads to infantile jaundice.

By focusing on whole-food sources like almonds, that provided vitamin E, healthy fats and proteins are present at the table, mothers can provide their infants with the foundation of a healthy start to life. The health of the newborn is inextricably linked to the maternal diet; by choosing nutrient-dense, antioxidant-rich foods, the expectant mother is not just eating for two, but she is building the biological infrastructure for a lifetime of wellness.

(Dr. Shobha Registered Clinical Dietitian, Manager, Dept of Nutrition & Dietetics, Cloudnine Group of Hospitals)

While mothers rightly deserve recognition for their strength during childbirth, fathers' efforts and support are often overlooked.

A recent social media debate involving Belgian footballer Jeremy Doku has reignited conversations about the role of fathers during childbirth.

The Manchester City winger's decision to consider leaving the World Cup to witness the birth of his child drew widespread admiration. What followed from a French TV presenter, however, drew something very different.

France Pierron, a presenter on French sports channel L'Equipe, called childbirth "a disgusting moment, excuse me, where the dad is useless" during an appearance on the television show.

The remarks sparked widespread backlash, prompting Pierron to apologise on X, saying the comments reflected only her personal opinion.

"These remarks are solely my own and in no way reflect a collective position," she posted on X. "I understand that they may have shocked, offended, or hurt some of you, and I am sorry for that."

Doku, meanwhile, returned to his team after the birth of his son to resume playing in the FIFA World Cup 2026.

Amid the debate, HealthandMe spoke to obstetricians and gynecologists to understand the role of fathers in the delivery room.

According to the experts, fathers are far from passive observers in the delivery room. They stated that a father's support before, during and after childbirth can positively influence both the mother's experience and the family's transition into parenthood.

Preparing for Labor

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Dr Richa Gangwar, Senior Consultant and Director of Obstetrics and Gynaecology at Clodunine Group of Hospitals, Lucknow, said a father's role begins well before labour.

Fathers must "attend antenatal appointments and childbirth classes, understand the stages of labor, discuss the birth plan with their partner and ensure hospital essentials are ready".

Supporting Mothers During Labor

According to Dr Richa, emotional support during labor can significantly reduce a mother's anxiety.

"A calm presence, words of encouragement, holding hands, maintaining eye contact and simply being there can make a positive difference," she said.

She also recommended fathers to help with breathing exercises, gentle back massages, position changes and reminders to stay hydrated, as guided by the healthcare team.

Dr Sonamm Tiwari, Robotic and Laparoscopic Gynaecologist at Gleneagles Hospital, Parel, Mumbai, added that fathers can further ease stress by encouraging deep breathing, communicating with doctors and helping mothers remain calm and relaxed throughout labour.

Also read: Sepsis: India Joins Global Trial To Screen Newborns For Deadly Drug-Resistant Infections

Advocating For The Mother

Dr Richa said fathers can also act as advocates by communicating the mother's birth preferences, asking questions when necessary and helping her understand information shared by the medical team, while remaining flexible if the birth plan changes.

The Role Continues After Birth

The experts emphasized that a father's responsibilities do not end after delivery.

Dr Richa recommended participating in early bonding, assisting with skin-to-skin contact, supporting breastfeeding and sharing newborn care.

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Dr Sonamm told HealthandMe that "fathers should also help with burping, diaper changes, bathing the baby, doctor's appointments, household responsibilities and providing emotional support to the mother during recovery".

She emphasized that "fathers should not underestimate their contribution, as their involvement helps build a strong foundation for parenthood".