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

A baby’s arrival is described as one of the happiest moments in a woman’s life. Families celebrate, relatives visit, pictures are shared, and everyone asks one question — “How's the Baby?” But very few pause to ask the mother, “How are you?”

Behind the smiles, celebrations, and sleepless nights, many women silently struggle with something far deeper than exhaustion: Postpartum Depression (PPD). Unfortunately, in many homes, it goes unnoticed, misunderstood, or dismissed as “normal after delivery.”

Postpartum Depression is a medically recognized mental health condition that can affect women after childbirth. It is not “drama,” “weakness,” “overthinking,” or simply a phase of tiredness. While many mothers experience temporary mood swings, crying spells, irritability, or anxiety after delivery due to hormonal changes and exhaustion — commonly known as the “baby blues” — these feelings usually settle within a few days.

However, when sadness, fear, hopelessness, anxiety, anger, emotional numbness, or exhaustion continue for weeks and begin affecting daily life, sleep, appetite, bonding with the baby, or relationships, it may indicate postpartum depression.

More Common Than We Think

Experts estimate that nearly 1 in 7 women may experience postpartum depression after childbirth. Yet many cases remain unrecognized because symptoms are often normalized within families. In many Indian households, women are expected to “adjust” immediately after delivery — manage breastfeeding, care for the baby, attend to guests, recover physically, smile constantly, and return to routine life within days. This pressure often prevents mothers from openly expressing emotional distress.

Many women feel guilty admitting that they are struggling because society expects mothers to feel joyful all the time.

Why Families Often Fail to Recognize It

One of the biggest challenges with postpartum depression is that it does not always “look obvious.” A mother may still feed her baby, smile in front of guests, continue household responsibilities, or post happy pictures online while silently struggling emotionally.

Sometimes, even mothers, sisters, or older women in the family unintentionally dismiss the condition because they compare it to their own experiences. Statements like “we also had babies, and we managed” are common. However, every pregnancy, delivery, body, emotional response, and support system is different.

Reading about postpartum depression online may create awareness, but self-diagnosis alone is not enough. Many women may not have the emotional agency, clarity, or support to seek treatment themselves — especially when their feelings are repeatedly dismissed as routine stress or hormonal changes.

How Can You Recognize Postpartum Depression?

Some common signs include:

· Persistent sadness or crying

· Extreme exhaustion beyond normal tiredness

· Anxiety, panic, irritability, or anger

· Feeling disconnected from the baby

· Difficulty sleeping even when the baby sleeps

· Guilt, hopelessness, or fear of being a “bad mother”

· Avoiding conversations or social interactions

· Emotional withdrawal or loss of interest in daily life

If these symptoms continue for more than two weeks, professional support should be considered.

How Families Can Help

The biggest support a new mother can receive is emotional validation. Instead of dismissing her feelings with statements like “You are dramatic” or “Is the baby healthy?” families should ask:

· “How are you really feeling?”

· “You don’t have to handle this alone.”

· “We are here for you.”

A new mother does not need constant advice, comparisons, or pressure. She needs rest, reassurance, emotional safety, and practical help. Small gestures like helping with the baby, preparing meals, managing household work, accompanying her for appointments, or simply allowing uninterrupted sleep can make a significant difference.

Most importantly, families should encourage professional support without shame. Postpartum depression is treatable, and seeking help is not a weakness. Treatment may include counselling, therapy, emotional support, lifestyle changes, support groups, or medical treatment when required. Recovery takes time, patience, and understanding.

Why Ignoring It Can Be Harmful

Untreated postpartum depression can affect a mother’s emotional and physical health, bonding with the baby, relationships within the family, confidence, and recovery after childbirth. Most importantly, it can leave mothers feeling deeply isolated during one of the most vulnerable phases of their lives.

The Conversation We Need to Start

Becoming a mother does not make women immune to emotional struggles. A woman can deeply love her baby and still battle postpartum depression. It is real, common, and treatable. The problem is not always that mothers are unable to speak — sometimes, it is that nobody is willing to listen. Every mother deserves to feel heard, supported, and cared for after childbirth. Because after delivery, healing is not only physical; emotional recovery matters too.

(Dr Shilva, Consultant – Department of Obstetrics & Gynaecology, Cloudnine Group of Hospitals, Panchkula)_

Infants who do not receive the recommended vitamin K injection at birth face a significantly higher risk of dangerous bleeding, including bleeding in the brain, according to a new study.

The findings, published in JAMA Pediatrics, reinforce the importance of the routine newborn vitamin K shot in preventing Vitamin K Deficiency Bleeding (VKDB), a rare but potentially life-threatening condition.

Higher Risk of Bleeding in Babies Without Vitamin K

Researchers from the Karolinska Institutet in Sweden analyzed data from more than 2 million live births between 2003 and 2021.

The study found that babies who did not receive an intramuscular vitamin K injection had:

• 1.52 times higher odds of any bleeding episode during the first six months of life.
• 2.91 times higher odds of intracranial (brain) bleeding during the same period.

"Our findings have important clinical implications, highlighting the ongoing need for communication between healthcare practitioners and parents about the vital role of vitamin K prophylaxis in preventing potentially life-threatening bleeding in newborns," said lead researcher Eleni Simatou of the Karolinska Institutet.

Why Is Vitamin K Important For Newborns?

Also read: 13.5 Million Children Remain Zero-Dose In 2025 Despite Global Vaccination Gains: UN Report

Vitamin K is a fat-soluble vitamin essential for normal blood clotting and bone health. Newborns naturally have very low vitamin K levels, putting them at risk of Vitamin K Deficiency Bleeding (VKDB).

The American Academy of Pediatrics (AAP) has recommended a vitamin K injection for all newborns since 1961. The shot is highly effective in preventing VKDB, which can cause severe internal bleeding, including bleeding in the brain, and may lead to permanent brain damage or death.

Importantly, the vitamin K shot is not a vaccine. It is a one-time supplement given shortly after birth to provide babies with adequate vitamin K.

Growing Concern Over Refusal of Vitamin K Shot

The researchers noted that parental refusal of vitamin K injections has been increasing in several countries.

A separate JAMA analysis of US electronic health records, published earlier this year, found that refusal rates rose from 2.92% in 2017 to 5.18% in 2024. In Sweden, however, only 1.5% of newborns did not receive the vitamin K shot in 2021.

"Vitamin K at birth is safe and effective," said study author Kate Semidey of Florida International University.

"Our review found that babies who do not get the vitamin K injection are 81 times more likely to develop vitamin K deficiency bleeding."

In addition to the US, the refusal is also growing in countries like Canada, New Zealand , and Scotland.

The authors noted that refusal also appears to be more common in home births, where reporting may also be less complete.

Read More: Cyclosporiasis Outbreak: US Probes Taco Bell Link; CDC Reviews Over 5,100 Cases

Breastfed Babies Remain at Higher Risk

Breast milk contains relatively low levels of vitamin K. As a result, babies who are exclusively breastfed remain vulnerable to VKDB until they begin eating solid foods if they do not receive the birth injection.

The study also found a higher use of oral vitamin K, which is considered less effective than the intramuscular injection in preventing VKDB, particularly the late-onset form that can occur weeks after birth.

Delhi's air quality has slipped into the 'poor' category for the first time in more than 85 days, even as the monsoon season sets in. While rainfall is often expected to clear the air, doctors warn that a combination of lingering pollution, high humidity, mold, allergens, and seasonal viral infections can significantly increase the risk of respiratory illnesses in children. Experts say children are especially vulnerable because their lungs and immune systems are still developing, making it easier for polluted air and environmental triggers to affect their breathing and long-term lung health.

After weeks of relatively clean air, Delhi's air quality deteriorated sharply on July 12, with the city's overall Air Quality Index (AQI) slipping into the 'poor' category at 261—the highest level recorded in more than 85 days.

According to Central Pollution Control Board (CPCB) data, this was the city's highest AQI since April 17, when it stood at 263.

Repeated exposure to polluted air during childhood can impair lung development and increase the risk of long-term respiratory diseases.

"Air pollution affects children more because their lungs are still developing, and they breathe faster than adults, inhaling more polluted air relative to their body weight," Dr. Narendra Kumar Jha, Director and Head of Pediatrics at Yashoda Medicity, told HealthandMe.

He added that inhaled pollutants irritate and inflame the airways, weakening the body's natural defense mechanisms. This can lead to chronic cough, wheezing, breathing difficulties, throat irritation, and worsening of conditions such as asthma and allergic rhinitis.

Why Children Are More Vulnerable

Children are not simply "small adults," said Dr. Nikhil Rajvanshi, Consultant, Pediatric Pulmonology, Madhukar Rainbow Children's Hospital, Delhi.

Because their lungs and immune systems are still developing, children breathe faster and inhale more air per kilogram of body weight than adults, making them more susceptible to pollution, infections, and environmental triggers.

How Air Pollution Affects Children's Lungs

According to Dr. Rajvanshi, pollutants such as PM2.5, PM10, nitrogen dioxide, and ozone penetrate deep into the lungs, triggering inflammation.

Even short-term exposure can cause:

• Coughing
• Wheezing
• Chest tightness
• Reduced exercise tolerance
• Increased emergency visits in susceptible children

Over time, repeated exposure can impair lung growth, reduce lung function, worsen asthma control, and increase the risk of chronic respiratory diseases later in life.

Why Respiratory Illnesses Increase During the Monsoon

Despite occasional rainfall clearing pollutants, the monsoon creates conditions that favor respiratory illnesses.

Dr. Rajvanshi explained that high humidity promotes indoor mold growth, damp conditions increase exposure to fungal spores, viral infections spread more easily, and sudden weather changes can trigger asthma. Periods of stagnant air between rainfall spells may also allow pollutants to accumulate.

As a result, pediatric clinics are reporting more cases of:

• Viral upper respiratory tract infections
• Persistent cough after viral illness
• Wheezing, especially in preschool-aged children
• Acute asthma attacks
• Allergic rhinitis with nasal blockage and sneezing
• Breathing difficulties linked to humidity, mold exposure, and fluctuating air quality

Children with asthma or allergies are particularly vulnerable, as viral infections combined with poor air quality can significantly worsen their symptoms.

How Parents Can Protect Their Children

Dr. Jha advised parents not to ignore persistent cough, breathing difficulty, or sleep disturbances caused by respiratory symptoms.

On days when pollution levels are high, children should avoid prolonged outdoor activities and strenuous exercise. Parents should also keep indoor air as clean as possible, ensure children stay hydrated, and continue prescribed asthma medications if needed.

Other preventive measures include:

• Monitor the daily AQI before outdoor activities.
• Keep children away from tobacco smoke, incense, mosquito coils, and indoor biomass smoke.
• Prevent dampness and mold inside the home.
• Clean regularly to reduce dust accumulation.
• Encourage frequent hand hygiene.
• Ensure adequate sleep, hydration, and a balanced diet.
• Continue prescribed controller medication and maintain an updated asthma action plan for children with asthma.
• Ensure eligible children, particularly those with chronic respiratory diseases, receive an annual influenza vaccination.

When Should Parents Seek Medical Care?

Parents should consult a pediatrician if a child develops:

• Fast or difficult breathing
• Wheezing or noisy breathing
• A cough lasting longer than two to three weeks
• Recurrent nighttime coughing
• Fever accompanied by breathing difficulty
• Poor feeding or lethargy in infants
• Bluish lips or fingertips
• Asthma symptoms that do not improve with prescribed reliever medication

Dr. Rajvanshi stressed that early medical evaluation can help distinguish between viral infections, asthma, allergies, pneumonia, and other lung conditions.

"Not every cough requires antibiotics, and not every episode of wheezing means a child has asthma. However, recurrent cough, persistent wheezing, exercise limitation, or breathing difficulty should never be ignored. Early diagnosis and appropriate treatment can prevent complications and improve long-term lung health," he told HealthandMe.