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

Vapes were marketed as a safer option than cigarettes, but research now shows they carry serious health risks -- from lung damage to meningitis to cancer.

Vaping has been a serious concern in the United States, with New York Attorney General Letitia James in 2025 filing a lawsuit against e-cigarette manufacturers and distributors.

The lawsuit accused the companies of fueling a youth vaping crisis, alleging that these companies that manufacture vapes, especially with flavors, have misled consumers about the safety of their products while deliberately targeting young people through deceptive marketing.

Now, a new study, published in JAMA Network Open, has for the first time assessed trends in young children's nicotine exposures across all types of products.

Shockingly, electronic cigarette-related incidents increased 243 percent over the past eight years in young children, especially among those under five years of age, said researchers from the Rutgers New Jersey Medical School.

In contrast, tobacco exposures from conventional products such as cigarettes decreased by 43 percent.

Unlike cigarettes, these devices are often ready to use, brightly colored, require little effort to activate, and appear more like toys than a harmful product.

"This significant spike in children breathing in these substances tells us the risk has changed: It's no longer just about a toddler swallowing something they found on the floor," said lead author Perry Rosen, who conducted the research at the New Jersey Poison Control Center.

"Many recent cases involve children actively using e-cigarette devices after gaining access to them," Rosen added.

Key Findings

The findings were based on an analysis of more than 92,000 reported nicotine exposures in children ages 5 and younger between 2016 and 2023.

The researchers noted that vaping risks often involved children who inhaled the vapors directly from the devices. They also found that children exposed to e-cigarettes were more likely to require a visit to a health care facility compared with those exposed to cigarettes.

According to researchers, young children naturally mimic the behaviors they see around them. So, parents and caregivers must keep vaping devices away from the reach of young children.

Previous research has shown that even moderate ongoing nicotine exposure can lead to lasting health effects on developing lungs, including increased risk of bronchitis and worsening asthma.

"When children see caregivers or older family members vaping, they may copy that behavior—bringing the device to their mouth and inhaling—without any understanding they are exposing themselves to a harmful substance," said Diane Calello, executive and medical director of the New Jersey Poison Control Center.

Vaping: A Concern

Vaping has become a more common form of tobacco use among American middle and high school students.

As per the US Centers for Disease Control and Prevention (CDC), nearly 1.6 million students used e-cigarettes in 2024, with 87.6 percent of them opting for a flavored product.

It is the flavor that makes it even more addictive, and people want to keep smoking it, resulting in it being emptied and refilled way more quickly.

This means those who smoke flavored cigarettes consume more tobacco than those who smoke unflavored ones.

Conceiving after 7 years of marriage—riddled with societal shame and self-doubt and a host of tests—was a moment of immense joy to Shalini, a 30-year-old IT professional.

Shalini was cared for, pampered, and showered with gifts. But the happiness was short-lived. At 10 weeks, her doctor delivered devastating news: there was no fetal heartbeat, and the pregnancy would have to be terminated.

Shalini couldn’t process; years of taunts of not being able to deliver a child came back to her ears—a voice so profound that she was unwilling to abort, let come what may.

However, in a week, the miscarriage occurred. She woke up at 2 am with intense abdominal pain and felt her womb rolling. She rushed to the toilet and found herself in a pool of blood. Her baby was gone.

For more than an hour, she continuously pushed out huge chunks of blood clots—the flesh of her unborn baby. Shalini cried. Then she went numb.

Doctors cleaned her up, but nobody bothered to heal her emotional burden—of not being able to deliver a baby successfully.

Years passed; Shalini delivered a healthy baby girl, but deep inside her, she still cries for her lost baby.

Shalini is not alone; more than one in five pregnancies worldwide end in miscarriage. While physical recovery is often addressed, emotional care is still met with silence.

The body may heal with treatment and nourishment, but internally, many women grapple with grief, anxiety, and a profound sense of loss that often goes unrecognized and untreated, said doctors, stressing the need for addressing the emotional toll.

What Is A Miscarriage?

A miscarriage is the loss of a pregnancy or the unexpected ending of a pregnancy in the first 20 weeks of gestation.

Most of them occur in 12 weeks and are classed as early miscarriages, while far fewer happen between 13 and 24 weeks.

Symptoms include

• vaginal bleeding,
• cramping like a period pain,
• decrease in pregnancy symptoms.

These occur when the fetus stops growing before 20 weeks.

As per the World Health Organization (WHO), miscarriage is the most common reason for losing a baby during pregnancy. WHO defines a miscarriage as a baby that dies before 28 weeks.

Miscarriage: Mental Health Implications

Also read:UK Women Who Suffer From Miscarriage May Get Two Weeks Paid Leave

Miscarriage often causes sadness, disinterest, sleeplessness, and depression. Many times, women experience low self-esteem and guilt.

There can also be marital issues, differences in psychological reaction of the spouse, and self-blame. There is also a sense of deep personal loss and trauma. It can lead to symptoms such as

• PTSD,
• feelings of yearning,
• emptiness,
• emotional numbing.

HealthandMe spoke to some mental health experts to understand what women who face the unexplained loss suffer.

“Miscarriage in women leads to many adverse consequences in psychological, social, marital, and physical domains. Most immediate effect is an acute feeling of loss, grief, and bereavement,” Dr. Savita Malhotra, President of the Indian Psychiatric Society, told HealthandMe.

She added that women who faced miscarriage can also feel anxiety over future pregnancies.

“About 20-30 percent of women after miscarriage show clear depression and anxiety. A similar number may show PTSD. Women who have an earlier history of miscarriage, trauma, or mental illness are more prone to mental ill health,” Dr Malhotra said.

Also read: Why Many Older Men Struggle to Conceive Despite ‘Good Health’

So why do women face these emotional turmoil?

"The lack of open conversation can intensify isolation, making women feel their pain is invisible or minimized. Social stigma and well-meaning but dismissive comments further deepen the wound," Dr. Chetna Jain Director Dept of Obstetrics & gynecology Cloudnine Group of hospitals, Gurugram, told HealthandMe.

Dr Deepak Raheja, a New Delhi-based psychiatrist, said that miscarriage is not just a medical event; for many women, it represents the loss of a deeply hoped-for future.

"Hormonal changes, lack of open conversations around pregnancy loss, and a tendency to internalize blame can make the emotional impact even heavier," the doctor told HealthandMe.

The experts urged the need for better familial support and good marital relationships that can prevent mental health issues in women.

Recognizing miscarriage as both a medical and emotional event is essential. Compassionate care, counselling, and supportive communities play a critical role in healing and long-term wellbeing.

Also read: Planning A Pregnancy In The 30s: Expert Answers FAQs On Women's Fertility in 30s

Dr Malhotra said, "There's a need for clear mental health intervention and psychiatric treatment."

"It is important to recognize miscarriage as a legitimate form of bereavement," added Dr Raheja.

Compassionate care from families and healthcare professionals, along with timely psychological support, can help women process the loss more healthily and gradually rebuild emotional resilience.