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

The IVF laboratory is a critical place where science and precision come together to help create embryos. Here, the expert explains the careful measures that take place inside the lab and the important role of the embryologist in helping couples achieve parenthood.

Many couples are battling infertility and are advised to undergo in vitro fertilization (IVF) to conceive. The couples tend to focus on various factors such as doctor consultations, hormone injections, and embryo transfer.

However, one of the most important parts of the treatment happens in the IVF laboratory. Couples are often unaware of what happens behind the closed doors in the IVF lab.

The IVF Lab: A Highly Controlled Environment

Did you know? Highly trained embryologists work with advanced technology when it comes to handling the eggs, sperm, and embryos in the IVF laboratory.

They are the ones who are responsible for planning and carrying out every step with accuracy to be able to give embryos the best possible environment for healthy development.

The lab is a controlled and sterile space wherein the temperature, humidity, air quality, and lighting are strictly monitored to be able to protect the delicate eggs and embryos.

Even small changes in the environment tend to impact embryo development, so strict quality standards are followed every day by the expert.

Also read: From Hope To Parenthood: How IVF And Embryology Are Changing The Fertility Journey For Couples

From Egg Retrieval to Fertilisation

The process commences after the woman's eggs are collected during a minor procedure. On the same day, the male partner will also provide a semen sample, or previously frozen sperm, if needed. The embryologist will examine both the eggs and sperm under a microscope to check the quality.

Then the healthiest sperm are selected to fertilise the eggs.

Fertilisation will occur after the egg and the sperm are placed together in a special culture dish or via a procedure known as Intracytoplasmic Sperm Injection (ICSI), wherein a single healthy sperm is directly injected into the egg.

The expert will decide the method after knowing the couple's fertility condition.

Also read: Delhi's Poor AQI, Monsoon Conditions Put Children's Lungs at Risk: Ways to Keep Kids Safe

Monitoring Embryo Development

When fertilisation happens, the embryos are placed in special incubators that closely mimic the conditions inside the human body.

Over the next few days, embryologists monitor their growth and development, and some embryos may undergo genetic testing to identify certain inherited or chromosomal conditions before they are transferred.

The Embryologist's Role in Ensuring Safety and Success

Understand that the embryologist maintains detailed records and follows strict identification protocols to ensure every egg, sperm, and embryo is accurately matched with the correct patient.

Hence, the embryologist plays a vital role in every successful IVF journey.

For decades, fertility has largely been viewed as a woman's responsibility. From tracking menstrual cycles and undergoing repeated tests to managing treatments, much of the focus has traditionally fallen on women.

However, medical science tells a different story. Male factors contribute to nearly 40–50% of infertility cases, making it clear that fertility is a shared journey that deserves equal participation from both partners.

Despite this, many men hesitate to discuss fertility or undergo evaluation due to stigma, misconceptions, or the belief that infertility is a woman's problem. This delay can postpone diagnosis and treatment, adding unnecessary emotional stress to couples who are already navigating a difficult path.

Reasons Behind Male Infertility

Environmental exposures and certain medical conditions may also affect sperm health. The encouraging news is that many of these causes are treatable or manageable when identified early.

A fertility assessment is not only straightforward but also essential. A simple semen analysis often provides valuable information about male reproductive health and can help guide the next steps in treatment.

When both partners are evaluated together from the beginning, the process becomes more efficient, avoiding unnecessary investigations and ensuring that the right treatment plan is developed sooner.

Also read: From Hope To Parenthood: How IVF And Embryology Are Changing The Fertility Journey For Couples

Importance Of Fertility Treatment

Equally important is the emotional role men play throughout fertility treatment. IVF can be physically demanding for women, but the emotional burden is shared by both partners. Feelings of anxiety, disappointment, hope, and uncertainty are common. Open conversations, shared decision-making, and emotional support can strengthen relationships and help couples cope better with the ups and downs of treatment.

World IVF Day serves as an important reminder that infertility is not about assigning blame—it is a medical condition that affects couples together. Breaking the silence around male fertility is essential to reducing stigma and encouraging earlier intervention.

When men become active participants rather than silent spectators, they help create a more supportive, compassionate, and successful fertility journey. Fertility care is most effective when both partners stand side by side, facing the challenge together with understanding, empathy, and shared responsibility.

By Dr Tejas Gundewar, Fertility Consultant, Ruby Hall Clinic, Pune

The process of becoming parents is one of hopes, anxieties, and numerous waits for many couples. Infertility does not only refer to a medical problem but is a psychological and sociological problem that can influence relationships, confidence, and overall psychological state of an individual. The World Health Organization states that about one out of six individuals experience infertility at some point in life.

Infertility Needs Couple-Based Evaluation

Infertility cannot be considered a problem for women only from the perspective of obstetrics and gynaecology. Infertility problems in women can be associated with ovulatory disorders, PCOS, endometriosis, blocked fallopian tubes, fibroids, decreased ovarian reserve, or declining quality of eggs due to the advanced age of the woman.

In men, infertility may relate to low sperm count, impaired sperm mobility or morphology. Correct diagnosis is the key point of developing the appropriate treatment program.

Also read: 'You Are Just Tired': When Postpartum Depression Goes Unnoticed At Home

IVF: A Scientific Pathway to Parenthood

With the emergence of in-vitro fertilization, known as IVF, people can now have children even if they do not possess the ability to conceive through natural means.

This technique is achieved through stimulation of ovaries, egg collection, fertilizing collected eggs using sperm in laboratory conditions, and implantation of a healthy embryo into the womb. Nonetheless, this method is not a simple one-time process but rather a medically guided journey. Every treatment is based on individual factors of the woman.

Embryology: The Silent Backbone of IVF

Embryology in the modern age has revolutionized the results of IVF procedures. Embryo selection can be done through procedures like ICSI, blastocyst culture, grading of embryos, cryopreservation and, in some cases, genetic screening to select healthier embryos.

ICSI is especially helpful in the case of male infertility, in which a single sperm is introduced into an egg.

Also read: Miles Apart, But Planning A Family Together: The Fertility Reality Of Long-Distance Marriages In India

Safer Pregnancy, Not Just Positive Pregnancy

The purpose of IVF is not just conception but the creation of a successful and safe pregnancy. In the past, many embryos were used to increase the chances of conception, but that caused complications with either twins or triplets. But now, because of better screening, fewer embryos can be transferred where appropriate, thus decreasing pregnancy risk. According to CDC figures, 37.5% of ART cycles ended in live-birth delivery.

The advances in IVF and embryology have revolutionized fertility treatments into an arena of hope and possibilities. With proper counselling, couples can embark upon their fertility journey with certainty. Being parents was once the dream of many people; however, with the advancements in the scientific field, science is now enabling many couples to fulfill this dream.

By Dr. Nisha Mangal, Senior Consultant - Obstetrics & Gynaecology, Cocoon Hospital, Jaipur