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

This common pregnancy drug could be linked to cancer. Wes Streeting has been urged to launch a public inquiry into a miscarriage drug called Diethylstilbestrol, which, reports say has "ruined and devastated" the lives of countless women. On Monday, the Health Secretary Streeting met victims of the pregnancy drugs, which has been linked to cancer, early menopause and infertility.

What Is Diethylstilbestrol?

Diethylstilbestrol, commonly known as DES, is a synthetic form of female hormone estrogen, which was prescribed to thousands of pregnant women from 1940 to 1970s.

The drug was used to prevent miscarriage, premature labor and complications of pregnancy. This was also used to suppress breast milk production, as an emergency contraception and to treat symptoms of menopause.

What Is The DES Controversy?

In 1971, Diethylstilbestrol (DES) was linked to a rare cancer of the cervix and vagina known as clear cell adenocarcinoma, prompting US regulators to advise that it should no longer be prescribed to pregnant women. Despite this, the drug continued to be given to expectant mothers across parts of Europe until 1978. DES has also since been associated with other cancers, including breast, pancreatic and cervical cancers, The Telegraph reported.

Campaign group DES Justice UK (DJUK) is now urging Health Secretary Wes Streeting to order a public inquiry and introduce an NHS screening programme to identify people who may have been exposed to the drug before birth.

Victims described DES as “one of the biggest pharmaceutical scandals this country has ever seen,” warning that “the impact of this terrible drug cannot be underestimated as it has ruined and devastated so many lives,” according to The Telegraph.

In November, Streeting acknowledged that the “state got it wrong” and issued an apology to those affected. He also advised anyone who believes they may have been exposed to DES to speak to their GP.

Susie Martin, 55, from Manchester, whose mother was prescribed DES during pregnancy, told The Telegraph she has undergone between 20 and 30 operations as a result of the drug’s effects.

“The impact of this terrible drug cannot be underestimated as it has ruined and devastated so many lives, including my own,” she said. “The physical and emotional pain has been unbearable. I live with a constant fear that I will need more surgery or develop cancer—and I am far from the only one.”

Calling DES a “silent scandal,” Martin said she hopes the government’s engagement will lead to concrete action. “While I welcome Mr Streeting meeting us, it will only matter if he commits to meaningful steps for victims of this shameful chapter in British medical history, including a screening programme and a full statutory public inquiry,” she added.

What Is Happening With The DES Victims?

The Telegraph reported that compensation schemes have been set up for DES victims in the US and Netherlands, however, UK does not have one yet.

"There are harrowing accounts of harm caused by the historic use of Diethylstilbestrol (DES). Some women and their relatives are still suffering from the associated risks of this medicine which have been passed down a generation, and haven’t been supported. The Secretary of State has been looking seriously at this legacy issue and carefully considering what more the government can do to better support women and their families who have been impacted. NHS England has alerted all cancer alliances to this issue so that healthcare professionals are aware of the impacts of DES and the existing NHS screening guidance which sets out the arrangements for those who show signs and symptoms of exposure,” said a Department of Health and Social Care spokesman to The Telegraph.

A large population-based study from Linköping University in Sweden has found no evidence that COVID-19 vaccination caused a decline in childbirth during the pandemic, countering persistent rumors that mRNA vaccines affect fertility. The findings have been published in the peer-reviewed journal Communications Medicine.

The study was conducted amid widespread misinformation, particularly on social media, suggesting that COVID-19 vaccines reduce the chances of becoming pregnant. These claims gained traction as several countries, including Sweden, recorded a drop in birth rates during the later stages of the pandemic, prompting questions about a possible link to vaccination.

“Our conclusion is that it’s highly unlikely that the mRNA vaccine against COVID-19 was behind the decrease in childbirth during the pandemic,” said Toomas Timpka, professor of social medicine at Linköping University and one of the study’s authors.

Why Researchers Investigated the Claim

Since the early months of the pandemic, unverified claims about vaccines and fertility have circulated widely online. When official data later showed fewer babies being born in some regions, researchers decided to examine whether vaccination could plausibly explain the trend or whether other social and demographic factors were at play.

Read: Ahmedabad Toddler Swallows Hulk Toy, Showed X-Ray, Doctors Remove It Via Endoscopy

To address the issue, the research team carried out an extensive analysis using real-world healthcare data rather than surveys or self-reported outcomes.

Study Looks at Nearly 60,000 Women

The study analyzed health records of all women aged 18 to 45 years living in Region Jönköping County, a region with a total population of around 369,000 people. This amounted to nearly 60,000 women included in the analysis.

Between 2021 and 2024, about 75 per cent of these women received at least one dose of a COVID-19 vaccine. Researchers examined data on childbirths, registered miscarriages, vaccination status and deaths using official healthcare records, allowing for a comprehensive comparison between vaccinated and unvaccinated groups.

Importantly, the researchers adjusted their analysis for age, recognizing that age is one of the most significant factors influencing fertility and pregnancy outcomes.

No Difference in Births or Miscarriages

When childbirth rates were compared between vaccinated and unvaccinated women, the researchers found no statistically significant difference. The same held true for miscarriage rates among women who became pregnant during the study period.

“We see no difference in childbirth rates between those who have taken the vaccine and those who haven’t,” said Timpka. “We’ve also looked at all registered miscarriages among those who became pregnant, and we see no difference between the groups there either.”

These findings align with several earlier international studies that have similarly found no association between COVID-19 vaccination and reduced fertility.

Other Factors Likely Behind Falling Birth Rates

According to the researchers, the decline in childbirth observed during the pandemic is more plausibly explained by broader demographic and social trends.

People currently in their 30s, the age group most likely to have children, were born in the second half of the 1990s. That period was marked by economic challenges and lower birth rates in Sweden, meaning today’s pool of potential parents is smaller than in previous generations.

In addition, pandemic-related factors such as health concerns, economic uncertainty, delayed family planning and lifestyle changes during lockdowns may have contributed to fewer pregnancies.

One of the study’s key strengths is its large, representative sample drawn from an entire region rather than a selected group. By using verified healthcare records and accounting for age-related effects, the researchers aimed to minimize bias and improve reliability.

The study received financial support from several sources, including the Swedish Research Council.

Ahmedabad toddler, one-and-a-half-year-old boy swallowed a 'Hulk' toy, which is based on a popular comic superhero. The toy was stuck in his stomach when his parents took him to the Civil Hospital. According to reports by News18, the child is identified as Vansh who showed the signs of discomfort and began vomiting. This is what alarmed the parents.

As per the News18 report, his mother Bhavika was suspicious when she noticed that one of his toys was missing. The child was rushed to the hospital and an X-ray revealed that he had swallowed the entire plastic toy. The toy was not broken.

Hindustan Times reported that Dr Rakesh Joshi, Head of the Department of Pediatric Surgery removed the toy through upper GI endoscopy. "Had it been a little late, the toy could have moved further from the stomach and got stuck in the intestines. In that case, there would have been a risk of intestinal blockage and even rupture," the senior doctor said.

"There is a natural valve between the esophagus and the stomach. The biggest challenge was to take out a whole toy through this valve. When we tried to grab it with the endoscope, the toy kept slipping because of the air in the stomach. Pulling the toy by its hand or foot raised the possibility of it getting stuck in the valve and causing it permanent damage," he said.

The doctor noted that if the toy had further slipped down, it would have increased the risk of intestine rupturing.

Ahmedabad Toddler Swallows Hulk Toy: What Parents Must Keep In Their Mind

Under the Toys (Quality Control) Order, 2020 issued by the Department for Promotion of Industry and Internal Trade under the Ministry of Commerce and Industry, toy safety in India was brought under mandatory BIS certification from September 1, 2020. The move aims to ensure safer toys for children while also supporting the government’s policy of curbing non-essential imports.

Industry sources estimate that more than 85 percent of toys sold in India are imported. Officials say the Toys Quality Control Order is a key step in preventing the entry of cheap and substandard toys into the domestic market, many of which fail to meet basic safety requirements.

Ahmedabad Toddler Swallows Hulk Toy: Standards for Electric and Non-Electric Toys

The quality control order clearly defines safety standards based on the type of toy. Non-electric toys such as dolls, rattles, puzzles, and board games must comply with IS 9873 (Part 1):2019. These toys do not rely on electricity for any of their functions.

Electric toys, which include at least one function powered by electricity, are required to meet the standards outlined under IS 15644:2006. Compliance with these standards is mandatory before such toys can be sold in the Indian market.

Ahmedabad Toddler Swallows Hulk Toy: Risks Linked to Untested Toys

Toys that are not tested by NABL-accredited toy testing laboratories can pose serious health risks to children. Sharp edges and poorly finished parts can cause cuts and injuries. PVC toys may contain phthalates, which are considered harmful chemicals.

Many low-quality toys have also been found to contain lead, a substance known to be particularly damaging to brain development in children. Soft toys with fur or hair can trigger allergies or become choking hazards. In some cases, small body parts can get stuck in gaps or holes, increasing the risk of injury.

Testing by NABL-accredited laboratories ensures that toys are safe, durable, and suitable for specific age groups. Parents are advised to check for IS marks on toys before purchasing, as this indicates compliance with Indian safety standards.

Ahmedabad Toddler Swallows Hulk Toy: What Parents Should Check Before Buying Toys

Experts recommend avoiding toys with small detachable parts for toddlers and young children, as they are more likely to put objects in their mouths. Toys should always match the child’s age, skill level, and interests.

Parents are also urged to look for IS marks, which confirm that the toy has been tested and certified. Loud toys should be avoided, as prolonged exposure to sounds above 85 decibels can harm a child’s hearing.

Electric toys with heating elements should be used with caution or avoided altogether due to burn risks. Finally, toys with sharp edges or shooting components should be carefully examined to prevent cuts and injuries.