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

For nearly a year after her first son was born, Belinda Stischok did not fully believe she was alive. In her mind, several realities had folded into one, and the life she was living felt like something else entirely - more like an afterlife, a different timeline, anything but the present.

This was not a dream or an ordinary breakdown.

It was — a condition most new parents have never heard of until it is too late — and one that is suddenly back in public conversation because of the ongoing Lindsay Clancy trial.

Clancy, on trial in Massachusetts, has told the court she heard a male voice in her head telling her, again and again, to kill her three children. She did so, and then jumped from a second-floor window, an act that left her paralyzed. Her defense says doctors repeatedly failed to grasp how serious her condition was and sent her home with heavier doses of medication instead of real intervention.

Diary entries read in court this week described a mind "desperate to get a mental break." Prosecutors have rested; the trial is ongoing.

For mothers who have lived through something similar, the case is not abstract. Belinda is one of them. Today she is healthy, married to her husband Kyle, and raising two sons in Florida. But getting there took nearly a year of a psychosis so consuming that, at its worst, she did not recognize her own child.

A Textbook Pregnancy, Then Silence

Also read: Lessons From The Lindsay Clancy Case: Can Families Spot Early Signs Of Postpartum Psychosis?

There was nothing about Belinda's background that suggested trouble ahead. A former personal trainer and competitive bodybuilder, she describes herself and Kyle as disciplined about health, careful about routine.

"Worrying about a mental health episode was never on the forefront of my mind," she said. "It wasn't anything I even knew could happen."

Her pregnancy was heavily researched and carefully planned - she wanted an unmedicated, natural birth. That plan started slipping the moment doctors pushed to break her waters during labor, against her wishes, and her own physician was not even available for the delivery. Looking back, she calls that her first real red flag.

At home with a newborn, she pushed herself hard, insisting on shifts, spotless floors, and constant vigilance. "Rest was never in my vocabulary," she said.

At her six-week check-up, she was given the Edinburgh Postnatal Depression Scale, a routine nine-question screening. She lied on every answer. "You don't want to answer these questions and then hear, oh, you're not well, we're taking your baby," she explained. She never mentioned the test to Kyle. Even with the lies, she was flagged for mild depression — and dismissed it.

When Reality Started To Splinter

The real break did not happen for another nine months. Kyle began noticing things that made no sense — Belinda staring directly into the sun for minutes at a stretch, filling pages with disjointed writing and equations.

"It was very unnatural," he said. "The only thing I could relate it to is that your wife is being possessed, because it's no longer her."

From the inside, Belinda describes it as her timelines collapsing into each other. She stopped believing Kyle was her husband or that their son was their son. She believed she had already died, and that this new life - the one she had once been told medically impossible - was some form of afterlife.

It is a description close to what Clancy has reportedly told people close to her: an out-of-body sense of having left her own life. Both women have described hearing voices, being placed on shifting combinations of psychiatric drugs, and having thoughts of harming someone.

Belinda's first hospitalization came after she barricaded herself outside the nursery, terrified someone would hurt her baby. It was 2020, and because of the COVID-19 pandemic chaos, no one told Kyle where she had been taken. He had to call hospital after hospital to find her.

She was still breastfeeding and says she "begged for a breast pump" — instead, she was sedated. She was held 72 hours, sent home with medication she later threw out, and noticed her breast milk had turned a strange greenish-blue from the drugs. She spent days pumping and dumping before feeding her son again.

Two weeks later, after an argument with her husband in the middle of a rough night, she walked out of the house barefoot and kept going, hearing voices telling her there was "better for you on the other side." A friend spotted her and alerted Kyle, who called the police.

This time, she was held for nine days, medicated with the antipsychotic Abilify, and placed in isolation, at times without access to a bathroom. During that stretch, Kyle, frightened and out of options, took their son and left to stay elsewhere.

"He was protecting our child," Belinda said. "I have no resentment." Still, she says learning her husband and baby were gone was the hardest single moment of the entire experience.

What The System Missed

Read More: Why Miscarriage Needs Emotional Care At Par with Medical Treatment: Doctors Explain

What stays with both of them is how little warning they were given. "They hand you a pamphlet for the epidural," Belinda said.

"Why not hand me one on what it means if you're not sleeping, not eating, not showering?" She is also open about how quickly the system reached for medication over conversation. However, she credits later talk therapy with a postpartum specialist for helping her recover.

Watching Clancy's trial, Belinda sees both familiar and unfamiliar territory. She hesitates to call what Clancy has described pure psychosis, pointing out that Clancy was journaling and naming her distress as it happened — something Belinda says she was incapable of doing herself.

"When you're in psychosis, you're not aware enough to seek help," she said. "You're already gone."

Belinda and Kyle went on to have a second son, delivered at home under a midwife's strict instructions: rest, bond, nothing else. It made all the difference.

Kyle's advice to other fathers is simple: "Don't give up, there's a light at the end of the tunnel."

Belinda's, however, is about permission: "It's okay to not be okay. You just have to seek help when you notice it."

She is also wary of how the Clancy case might land on struggling new mothers. "It can help mothers understand this can happen to anyone," she said, "but I worry the hate people are throwing at Lindsay online will stop other moms from speaking up."

For Belinda, that fear is exactly why she chose to tell her own story out loud.

With the onset of the monsoon season, the heat of the summer is no longer an issue; however, it ushers in an invisible threat to public health. With stagnant water being the perfect breeding ground for Aedes and Anopheles mosquitoes, diseases such as dengue, malaria, and chikungunya cases increase dramatically among both rural and urban areas in India.

For the young ones who have not yet developed a fully functional immune system, a simple bite could cause dehydration, high fever, and other serious complications. However, in an effort to ensure their children are protected, the mothers use harmful insecticides which inadvertently end up putting their sensitive skin and breathing tract in harm’s way.

The Hidden Danger: Chemical Exposure vs. Vector Risk

The skin of a baby is 30% thinner than that of an adult and thus highly permeable, making it possible for chemicals absorbed through the skin to enter the body very fast.

It has been emphasized by international pediatric guidelines that babies under two months old should never come into contact with any chemical repellent on their skin.

Also read: Beware! Common Mistakes New Parents Make During Their Baby’s First Monsoon

The Gold Standard: Physical Barriers Over Chemical Sheaths

With regard to safety in infants, there is no question that non-chemical physical barriers are always the foremost priority. The use of cot, stroller, and window nettings that have apertures smaller than 1.2mm prevent mosquitoes from getting access to the sleeping areas without compromising air flow and without releasing any toxic chemicals into the nursery environment.

In addition, it is important to note that careful selection of appropriate clothes is essential; this means choosing loose-fitting and light coloured full body cotton clothes for the infant as they will naturally protect them as dark colours attract mosquitoes and tight clothes will give them easy access to the body for biting.

Also read: Milestone In Kala-Azar Treatment: WHO Updates Treatment Guidelines, Recommends Shorter & Safer Regimens

Smart Protocol: Fabric-Only & Botanical Innovation

As a method of active protection outdoors or for biting time in the early mornings and evenings, parents must resort to fabric application only. The natural roll-ons and patches that use botanicals such as Citronella, Eucalyptus, and Lemongrass oil must be used only on the outside of the hem of clothes, strollers, or cot corners and never on the body of the baby.

Also, the use of chemical vaporizers or coil repellants in an enclosed nursery where the child is sleeping must be avoided as these are inhaled and can cause irritation of the air passage.

By Dr. Bharat Jain, Senior Consultant Paediatrician and Neonatologist, Cocoon Hospital, Chandigarh

Vitamins and minerals are often consumed for better health and immunity, but a new US study is drawing focus to a danger that may get overlooked. The danger is toxicity if vitamins and minerals are ingested in excessive quantity, particularly for children.

Researchers found that 1,961 children were hospitalised for vitamin and mineral toxicity over a three-year period, according to findings presented at the Pediatric Hospital Medicine 2026 meeting in Kansas City, Missouri.

The researchers used data from the federal Healthcare Cost and Utilization Project Kids’ Inpatient Database, which captures hospital admissions involving children across the US.

But the figure may represent only a part of the problem. “Our study probably only scratched the surface,” lead researcher Marina Masciale, MD, MPH, of Baylor College of Medicine, said while presenting the findings.

Most Poisoning Cases Were Due To Intentional Ingesting

One of the most interesting findings was that the majority of hospital admissions due to vitamin and mineral toxicity was due to intentional ingestion.

That makes the issue different from a child accidentally swallowing one or two tablets. Researchers say the findings highlight the need to consider supplements when assessing children who may deliberately ingest potentially harmful substances.

The database also captured only supplements for which there was a specific toxicity-related ICD-10 diagnostic code. This means poisonings involving supplements that were not coded in this way may not have been included. As a result, the researchers believe the true number of affected children could be substantially higher.

Also read: Is Your Child Suddenly Sluggish, Clumsy? Signs Of Juvenile Arthritis Parents Miss

Why Are Children Getting Poisoned If Vitamins Are Supposed To Be Safe?

The body requires many micronutrients in relatively small quantities. Some can become harmful when taken in excessive amounts, particularly certain fat-soluble vitamins that can accumulate in the body.

Minerals can also cause toxicity when consumed in excessive quantities. The symptoms and severity depend on the substance, dose and how quickly treatment is provided.

This is why supplements should not be popped like harmless candies simply because they are sold over the counter.

Also read: Too Much Cow’s Milk Linked To Severe Iron Deficiency In Toddlers, Including Three Deaths

Why Children Are Particularly Vulnerable?

Many supplements also come in colourful, flavoured or chewable forms, making them particularly attractive to younger children.

But the new findings highlight another concern: older children and adolescents may deliberately consume large quantities of supplements, meaning prevention cannot rely only on keeping bottles out of reach.

Parents and caregivers should therefore store vitamins, minerals and other supplements securely and treat them like medicines rather than everyday food products.

What Should Parents If They Suspect An Overdose?

If a child may have swallowed a large amount of vitamins or minerals, parents must not wait for symptoms to appear.

The exact risk depends on what was taken, how much was consumed and the child’s age and weight. Some toxic effects may not be immediately evident.

Medical professionals may need information from the supplement label, including the ingredients and strength, to determine the appropriate treatment course.