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

Catherine Paiz, is pregnant at 35 and is expecting her fourth baby. This is her first with husband Igon Ten. Paiz shared the news on her Instagram page and wrote that she was "so shocked" to learn the news about her pregnancy.

On her Instagram post, she wrote: "I'm pregnant!!!!! Still so shocked ahhhhh". She also included videos of her taking the pregnancy test, where she could be heard saying, "Last night I peed about five times and I'm curious. I'm confused. I'm exactly one month from the day I got married today. It is the 27th of October."

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Paiz pregnancy at 35 has yet again sparked spotlight on late motherhood trends. In fact, data also shows the same trend.

The Trend Of Late Motherhood

The average age of mothers in the US have continued to rise, a new report released on June 13 by the National Vital Statistic System (NVSS), provides the shift in age trends between 2016 and 2023. The study, conducted by Andrea D. Brown, Ph.D., M.P.H., and her colleagues at the National Center for Health Statistics.

The researchers found a clear increase in the mean age of mothers at the time of their first birth. In 2016, the average age of a first-time mother was 26.6 years. By 2023, this had risen to 27.5 years — nearly a full year’s difference in just seven years.

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But the trend isn’t limited to first-time mothers. In Paiz's case, she is having her fourth child at 35.

Is Late Pregnancy Healthy?

The National Institute of Health (NIH), US (2022), 20% of women in the US are now having their first child after the age of 35. While it is the new trend, the NIH doctor Dr Alan Decherney, a fertility expert explains that "As women age, they are still fertile, but their odds of pregnancy are decreased because they are not making as many good eggs that will fertile and divide normally and turn out to be an embryo."

After age 30, a woman's fertility decreases ever year, notes the NIH July 2022 issue. It notes: "The number and quality of her eggs goes down until she reaches menopause."

However, experts do point out that getting pregnant in your 30s need not be a stressful affair at all times. As it is at this age when you experience more stability, and also someone you know who have a personal experience in handling one. Most important, you are more mature at this age, which you may not be in your 20s.

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What Must You Keep In Mind If You Plan Pregnancy After 30?

Quit Habits: If you are a smoker, or consume alcohol, this is a good time to leave it.

Reduce Stress: While pregnancy for some can bring stress, try to find activities that help you release it.

Healthy Weight: Ensure that your weight is right, reduce your waist to bring it to a healthy range for a healthy pregnancy.

Food Habits: Stop eating junk and start eating more whole grains.

Exercise: A sedentary lifestyle can impact negatively on the child. You do not have to do HIIT, however, regular easy workouts can make both the pregnancy and delivery easy.

Dr Michelle Y Owens, professor of obstetrics and gynecology and a practicing maternal-fetal medicine specialist at the University of Mississippi Medical Center in Jackson, writes for the American College of Obstetricians and Gynecologists (ACOG) that "the longer your eggs have been around, the more likely they are to produce a pregnancy with a chromosome problem that can lead to a condition like Down syndrome. The risk goes up significantly after 35." However, she says, there is a good news. Now, we have tools to detect and respond to pregnancy complications early.

Since October 19, the PM2.5 levels, which is one of the key pollutants, in Delhi has hovered well above 120 micrograms, while even crossing 200 a couple of times. While the World Health Organization (WHO) guidelines recommend the average PM2.5 levels to be at 15 micrograms per day, reported Healthy Policy Watch. In June 2023, when New York hit PM2.5 levels of 117 micrograms, advisories were issued to shut down schools, for people to remain indoors, and to wear masks. However, there have been no such advisory in Delhi so far.

The data on Delhi pollution has been unreliable, several media outlets have reported the discrepancy between the official data and the on ground data. Many videos online have also shown the gap between these data where people are using their private AQI machines to measure the air quality. Furthermore, a video from opposition legislator Saurabh Bharadwaj that showed water being sprinkled around a government-run air monitoring station in the city on Diwali night have also raised questions on whether the data was tampered.

Amid all this, while doctors have time and again have asked everyone to stay safe, wear mask, and avoid going out during peak hours, studies too have shown fatal links with worsening air pollution. Now, there is an increased risk for infants too. Dr Anjana Singh, director and head of Obstetrics and Gynaecology at Fortis, Noida, as told to the Indian Express said, "Nowadays each newborn is spending a longer time in the nursery before they can be discharged because they are born with respiratory problems and their lung function needs to be stabilised. Some of them have delayed lung development and congenital asthma later. More and more babies are being born with jaundice."

Pollution And Infant Health

The doctor points out that pollution has a deep impact on fetal development than one may think. "It is the reason why we are seeing many more cases of miscarriage, pre-term births, stillbirths, birth defects, congenital heart disease and neural tube defects (the brain and spine do not develop properly)," the doctor explains.

Toxic particles can cross the placenta, the temporary organ that links a baby to the mother through the umbilical cord, and disrupt normal development. They trigger inflammation in the placenta, which creates resistance to blood flow. Over time, the blood vessels become damaged, reducing the amount of blood reaching the fetus.

Air pollution can mess with how nutrients reach the baby, which often leads to low birth weight. Research also shows that when a pregnant woman is exposed to polluted air, the risk of stillbirth goes up, especially in the third trimester.

High levels of fine particulate matter (PM2.5) are linked to low birth weight and premature birth, both of which can cause other health problems. Tiny sooty particles can move through the mother’s bloodstream to the placenta and affect the baby’s lung development, raising the risk of lifelong breathing issues like asthma.

Pollutants such as nitrogen dioxide and PAHs which come from things like burning food, coal, oil or gas can disrupt how organs form. This can increase the chances of conditions like congenital heart defects, neural tube problems or cleft palate. Some studies also suggest that heavy exposure to air pollution during pregnancy may raise the risk of autism spectrum disorder.

Air pollution can also push the mother’s blood pressure up, increasing the risk of preeclampsia, which is dangerous for both mom and baby.

Microplastics in the air come from synthetic clothes, car tires and broken down plastic waste. They act as endocrine disruptors, meaning they can interfere with hormones during key stages of development. They’ve been linked to gestational diabetes, inflammation and gut microbiome imbalance. Microplastics have even been found in the placenta, umbilical cord and cord blood, showing they can reach the baby and interfere with organ and nervous system development.

Children are known for hopping from one activity to the next, often when they should be focusing on just one thing. This is a common experience for parents and teachers. A new study suggests that this behavior is not just because kids are naturally curious. Instead, the real reason has a lot to do with the way their younger brains are still growing and working.

Children have a characteristic less attention span, and many people believe that it is simply because the children don’t find it interesting enough, however the study proved that this is not true. Published in the Journal of Experimental Psychology: General, researchers discovered that children's ability to stay focused on one task is limited because their working memory is not yet fully developed.

Why Do Children Have Less Attention Span?

Working memory is like the brain’s temporary notepad, it holds information needed to complete a task. When this memory gets overloaded, children can't stay "locked in" on a single job.

Researchers at Ohio State University essentially forced adults to behave like young kids during a task. They found that when an adult's working memory was filled up, their attention scattered, and they started acting just like young children.

To create the "kid-like" condition, some of the adults were asked to do a second, very difficult task at the same time as playing the candy game. This second task required them to intensely focus on a screen full of numbers and immediately shout out whenever they saw two odd numbers appear right after each other.

This extra mental effort, or load, completely soaked up their working memory, making it much harder for them to stay focused on finding the best candy character.

How Do People Concentrate?

The study included 40 five-year-olds and 71 adults who played a computer game. In the game, participants collected virtual candy from four cartoon characters. Each character always gave a different, fixed amount of candy (1, 2, 3, or 10). The goal was to figure out which character gave the biggest reward.

Some of the adults were given a second, demanding task to do at the same time: they had to watch numbers streaming by and call out when two odd numbers appeared in a row. This extra mental load made it much harder for them to focus on the candy game.

What Causes Scattered Attention In Kids?

Everyone, including the children and the distracted adults, was able to figure out which character gave the largest candy reward. However, the adults whose memory was overloaded, just like the young children, kept switching between characters instead of sticking to the best choice.

Researchers explained noted that this scattered attention happened even when participants knew the correct answer. The finding suggests that what we see as simple distraction in kids might actually come from a brain that is still developing.

The results change how we should view a child's attention span. They suggest that a child's natural tendency to switch focus might actually be a good thing, helping them learn in ways that are more flexible and adaptable than adults. It's not a weakness. This vital research could help teachers and parents create new teaching methods that work with a young child's natural way of learning, instead of always trying to make them concentrate against their developing brain's natural tendencies.