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

While you may be buying fast-fashion clothes that are easy on your pocket and also give your children trendy looks, a new study highlights the risk of being laced with a highly toxic ingredient: lead.

The preliminary research, based on lab tests of several shirts from different retailers in the US, found that all the samples exceeded the country’s federal regulatory lead limits.

The US Consumer Product Safety Commission currently has a 100 parts per million (ppm) lead limit for children's products like toys and clothing.

"I started to see many articles about lead in clothing from fast fashion, and I realized not too many parents knew about the issue," said Kamila Deavers, principal investigator of the study, at Marian University in the US.

Deavers began the study after her young daughter’s lab reports showed elevated levels of lead in her blood from toy coatings.

How was study conducted?

The team tested 11 shirts that spanned the rainbow—red, pink, orange, yellow, gray, and blue. All brightly colored fabrics, particularly reds and yellows, showed higher levels of lead compared to more muted tones.

"We saw that the shirts we tested were all over the allowed limit for lead of 100 ppm," said Priscila Espinoza, from Marina.

The researchers explained that some manufacturers use lead (II) acetate as an inexpensive way to help dyes stick to the materials and produce bright, long-lasting color.

Children At Greater Risk

The researchers found the risk is particularly higher among younger kids as they tend to playfully suck or chew their clothes during play.

"Even briefly chewing these fabrics could expose children to dangerous lead levels,” they found in the study, to be presented at the forthcoming meeting of the American Chemical Society.

According to the US Environmental Protection Agency (EPA), lead exposure can lead to behavior problems, brain and central nervous system damage, as well as other negative health effects in children.

The agency considers children under six years old to be most at risk from exposure. Even low levels of lead in the blood of children can result in:

• Behavior and learning problems
• Lower IQ and Hyperactivity
• Slowed growth
• Hearing Problems
• Anemia

The researchers also pointed out safer alternatives to lead-based dyeing agents that already exist. These include natural and less harmful substances such as:

• Plant-based tannins (e.g., oak bark, pomegranate peel)
• Rosemary
• Alum.

A recent systematic review published in the European Medical Journal found that racial discrimination leads to postpartum depression and low birth weight (LBW). Pregnant women of color were 40 per cent more likely to experience postpartum depression and have 170 per cent higher risk of delivering a baby with LBW.

The findings allowed the researchers to report that racial discrimination is a modifiable determinant of maternal and nenonatal health. Researchers also note that they should be integrated into perinatal research and care to reduce inequalities.

Large Review Examines Decades of Research

A large review of international studies has found that racial discrimination experienced by pregnant women may be linked to a higher risk of postpartum depression and poor birth outcomes, including babies born with low birth weight.

Researchers analysed nearly three decades of research that examined self reported experiences of racial discrimination among pregnant women or those who had previously been pregnant. The analysis included more than 20,300 research records and covered close to 1.5 million participants.

The study explored whether exposure to racial discrimination was associated with a range of maternal and newborn health outcomes. These included hypertensive disorders during pregnancy, gestational diabetes, mode of delivery, postpartum depression, fetal growth, gestational outcomes, infant mortality, and admission of newborns to neonatal intensive care units.

Among all the outcomes studied, the strongest link was found with postpartum depression. Women who reported experiencing racial discrimination had a 37 percent higher risk of developing postpartum depression compared with those who did not report such experiences.

Higher Risk of Low Birth Weight Among Affected Mothers

The analysis also found significant associations between racial discrimination and low birth weight in babies.

Women who experienced racial discrimination were found to have a 121 percent higher risk of delivering babies with low birth weight. The risk was even greater for very low birth weight babies, with the likelihood increasing by 170 percent.

However, researchers did not find clear links between racial discrimination and certain pregnancy complications. No strong association was observed with hypertensive disorders of pregnancy or gestational diabetes.

Findings related to preterm birth were mixed. Cohort studies did not show a clear association, while cross sectional studies suggested a modest 19 percent increased risk of premature birth among women who reported discrimination.

For several other outcomes studied, the available evidence remained inconsistent.

Stress and biological changes may explain the link

Researchers suggested that everyday experiences of racial discrimination may affect maternal health through multiple pathways.

Repeated exposure to discrimination can create chronic stress, which may affect both mental and physical health during pregnancy. The stress can also lead to social isolation and strained personal relationships, which may increase the risk of postpartum depression.

Biological changes triggered by prolonged stress may also affect pregnancy outcomes. Researchers noted that stress linked to discrimination could influence placental function, metabolism, and inflammatory responses in the body. These changes may contribute to restricted fetal growth and increase the risk of babies being born underweight.

Experts call for stronger public health response

The authors emphasized that healthcare systems should recognize racial discrimination as an important social stressor that can influence maternal and newborn health.

They recommend that routine prenatal care include screening for social stressors along with mental health assessments during pregnancy and after childbirth.

Currently, many clinical guidelines do not explicitly recognise racial discrimination as a potential risk factor for maternal and neonatal health.

Researchers say the evidence highlights the need for broader policy efforts that address discrimination at a structural level. Treating discrimination as a public health issue rather than an individual experience may help reduce health inequalities and improve outcomes for mothers and babies.

An estimated 4.9 million children died before reaching their fifth birthday in 2024, including 2.3 million newborns, according to the latest United Nations report on global child mortality. The findings were released in the report Levels and Trends in Child Mortality, which examines the leading causes of deaths among children worldwide.

The report notes that many of these deaths could have been prevented through simple and affordable health measures. Access to quality healthcare, timely treatment, vaccination, and better nutrition remain key factors in reducing child deaths.

Over the past two decades, the world has made significant progress. Global under five deaths have dropped by more than half since 2000. However, the pace of improvement has slowed in recent years. Since 2015, the rate of decline in child mortality has fallen by more than 60 percent, raising concerns among health experts.

India Shows Steady Progress In Reducing Child Mortality

Despite global challenges, India has made notable progress in improving child survival rates through sustained public health efforts.

According to the United Nations Inter Agency Group for Child Mortality Estimation (UNIGME) Report 2025, India has steadily reduced deaths among newborns and young children over the past decades. The Union Health Ministry said the country has played an important role in lowering child mortality across South Asia.

India’s Neonatal Mortality Rate, which measures deaths within the first 28 days of life, has seen a major decline. In 1990, the rate stood at 57 deaths per 1,000 live births. By 2024, it had dropped to 17.

A similar trend was seen in the Under Five Mortality Rate. In 1990, India recorded 127 deaths per 1,000 live births among children under five. By 2024, that number had fallen sharply to 27.

Health officials attribute this progress to targeted public health programmes, improved hospital deliveries, and wider vaccination coverage.

Malnutrition And Infections Still Claim Many Young Lives

The report highlights that several preventable health conditions continue to drive child deaths across the world.

For the first time, the report estimated deaths directly caused by severe acute malnutrition. It found that more than 100,000 children aged between one month and five years died due to severe malnutrition in 2024.

Experts believe the real impact may be even higher because malnutrition often weakens the immune system. This makes children more vulnerable to common infections such as pneumonia, diarrhea, and malaria, which can become life threatening.

Some countries reporting high numbers of malnutrition related deaths include Pakistan, Somalia, and Sudan.

Newborn Complications Remain A Major Concern

Nearly half of all deaths among children under five occur during the newborn stage. This reflects slower progress in preventing deaths around the time of birth.

The leading causes of newborn deaths include complications related to premature birth, which account for about 36 percent of cases. Problems during labor and delivery contribute to around 21 percent of deaths.

Other important causes include infections such as neonatal sepsis and certain birth defects.

After the first month of life, infectious diseases remain the main threats to children’s survival. Malaria, diarrhea, and pneumonia are among the biggest causes of death.

Health Experts Stress Need For Continued Investment

The report also points out that global funding for maternal and child health programmes is facing increasing pressure. This could slow progress in reducing child deaths in the coming years.

Experts stress that investing in child health remains one of the most effective public health strategies. Basic interventions such as vaccination, treatment for severe malnutrition, and skilled care during childbirth can save millions of lives.

According to the report, such measures not only improve health outcomes but also strengthen economies by creating healthier and more productive populations.