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

Even as the Indian Meteorological Department (IMD) continues to predict rising temperatures and heatwaves in most parts of India, especially in Delhi, doctors flag a quiet but terrible effect that can alter the demographics of the country.

Heatwave conditions are likely to persist in Delhi-NCR from April 23 to 25, with maximum temperatures expected to climb by 1-2°C and remain above normal for at least five days, according to the latest weather bulletin by the India Meteorological Department. The mercury has already been hovering between 40°C and 42°C.

Some parts of the national capital on Friday recorded the season’s first heat wave, even as the India Meteorological Department issued a yellow alert, warning that similar conditions may continue on Saturday.

Beyond Delhi, heatwave conditions are likely to continue over the plains of northwest and central India, including parts of Punjab, Haryana, Rajasthan, Madhya Pradesh, and Uttar Pradesh.

India is already seeing a drop in fertility rates, reaching the replacement level of 2.0 as per the National Family Health Survey

-5 (2019-21) and continuing to decline to 1.9 by 2023 in the Sample Registration System report.

But with rising heat, both male and female reproductive health could be at risk.

Emerging research suggests that extreme heat can disrupt hormonal balance, reduce fertility in both men and women, and even affect pregnancy outcomes. From lowering sperm quality to interfering with ovulation, scorching temperatures may have deeper biological consequences than many realize.

Heatwave And Women’s Reproductive Health

Dr Archana Dhawan Bajaj, a gynaecologist and IVF expert at Nurture IVF Clinic, noted that heat stress can directly affect hormonal balance.

“During extreme heat conditions, we see women coming in with complaints of irregular menstrual cycles, delayed periods, and worsening symptoms of conditions like PCOS."

"The body’s hormonal system is extremely sensitive to environmental stress, and prolonged heat exposure can disrupt normal functioning in ways that are often overlooked,” she said.

Working in extreme heat can double the risk of stillbirth and miscarriage for pregnant women, according to 2024 research from India published in the BJOG: An International Journal of Obstetrics and Gynaecology.

A 2025 study led by researchers from the Arizona State University in the US showed that thermal stress reduces sperm quality and increases miscarriage risk.

Heat stress could disproportionately impact vulnerable populations, especially in low-income countries. Heat and air pollution could synergistically worsen reproductive health outcomes.

Heatwave: The Impact On IVF Outcomes

Dr. Hrishikesh Pai, Consultant Gynaecologist & IVF Specialist, Lilavati Hospital, Mumbai, highlighted that the rising temperatures are not only hurting natural pregnancy but also affecting outcomes of fertility treatments like IVF.

"We are seeing extreme heat during the summer months for the last couple of years. This is making pregnancy more challenging for some women due to poor egg quality and implantation difficulties," he said.

Dr Pai noted that as a result, women with reduced chances of natural conception are moving to "assisted reproductive techniques like IVF, but environmental and lifestyle factors are increasingly playing a role in treatment outcomes."

Heatwave: Impact on Sperm

Further, men’s health is also being impacted, particularly when it comes to fertility.

A 2024 study by Argentine researchers, published in the journal Science of the Total Environment, showed that semen from men exposed to heat waves had lower sperm number and abnormal morphology.

The differences were 4–5 times higher in peak heatwave years (2013, 2023). Heat wave length was negatively associated with semen quality.

“Rising temperatures are a serious but often overlooked risk factor for male infertility. The testicles need a cooler environment compared to the body to function properly in producing sperm. Any slight increase can affect their numbers and quality," said Dr Vineet Malhotra, Head of Urology and Director, VNA Hospital.

"When exposed to hot temperatures over an extended period of time, especially in urban areas, there is an increase in low-quality sperm, genetic mutations, and infertility in men,” he added.

How To Prevent?

The experts urged both men and women planning pregnancy to

• Avoid prolonged periods in the heat.
• Take regular shade breaks if working outdoors on hot days.
• Avoid exercising or sunbathing for long periods in the hottest part of the day.
• Wearing light clothing,
• Maintain proper hydration.

Even as the Indian Meteorological Department (IMD) issued a yellow alert for heatwave and rising temperature in Delhi, the state government issued guidelines for all schools, focusing on hydration and safety measures.

The IMD has forecast heatwave conditions at isolated places in Delhi from today, with maximum temperatures expected to climb between 41 °C and 44 °C through April 24.

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The guidelines issued by the Directorate of Education (National Capital Territory of Delhi) are applied to all government-aided and private unaided recognized schools. The guidelines call for:

Outdoor Assemblies: Outdoor assemblies are to be curtailed or conducted in shaded/indoor areas with minimal duration. No open-air classes are to be conducted.

Water Bell Initiative: Schools shall implement a "Water Bell" system, whereby a bell is rung at regular intervals (every 45-60 minutes), reminding students to drink water to prevent dehydration.

Display of IEC Material: IEC (Information, Education and Communication) material issued by the Health Department, Government of NCT of Delhi, on heat wave precautions shall be prominently displayed at visible locations in schools, including notice boards, corridors, and classrooms.

Awareness Sessions: Schools shall conduct short awareness sessions/briefings for students during class hours/assembly to educate them about preventive measures, the importance of hydration, and the identification of symptoms of heat-related illnesses. Immediate first aid and medical attention must be ensured wherever required.

Buddy System: Establishing a buddy system wherein each student may be paired up with another student during school hours to monitor and take care of each other's physical well-being.

Outdoor Activities: It must be ensured that students avoid outdoor physical activities.

Regular Advisory Updates: Class teachers shall share advisories of the India Meteorological Department (IMD) with parents through their respective class-specific WhatsApp groups, ensuring regular guidance and awareness regarding heat safety measures. Schools shall share daily heat wave forecasts and alerts with students through prayer time/assembly and notice boards to ensure timely awareness and necessary precautions.

Appropriate Clothing and Personal Hygiene: Parents are advised to ensure that their wards come to school dressed in light, breathable cotton clothing. They should also reinforce the importance of personal hygiene, including daily bathing, to help children stay fresh and reduce the impact of heat.

The DoE also directed each school to designate nodal officers who will be responsible for the implementation of monitoring the water bell initiative, awareness sessions, and display of IEC materials.

Heat-Related Illnesses: Symptoms And First Aid Measures

The DoE noted that the symptoms of heat-related illnesses include:

• Nausea and increased sweating
• Vomiting
• Acts or talks confused
• Muscle cramps
• Fainting,
• Weakness,
• Dizziness
• Body temperature rises to 40.5°C (105°F) or higher

First aid measures to follow if you feel dizzy or uneasy

• Drink water to rehydrate
• Move to a cooler place immediately
• Loosen clothes if possible
• Sponge with water
• If unconscious, do not force-feed or give water
• If symptoms persist, immediately visit the nearest health centre or call an ambulance.

Heatwave In India: Which States Are On Alert?

Beyond Delhi, a heatwave alert has been issued for:

• East Uttar Pradesh from April 21 to 25.
• Madhya Pradesh, Chhattisgarh, and West Uttar Pradesh from April 22 to 25,
• Odisha and Rajasthan between April 23 and 25.
• Gangetic West Bengal and Bihar for April 21 and 22,
• Vidarbha from April 24 to 26.

Digital devices have become the new pacifiers, said Zerodha co-founder Nithin Kamath, raising concerns about the growing impact of excessive screen time on children's behavior and brain development.

Posting a video of cognitive neuroscientist Jared Cooney Horvath on his social media platforms, Kamath warned that while digital devices often help parents manage their schedules, they can also create long-term dependency among children.

"For most parents, digital devices have become a pacifier; it's a way to keep 'em quiet, and it's understandable, but it ends up creating a dependency in the long run," Kamath said.

In the video, Horvath spoke about a decline in learning abilities among younger generations due to the increasing screen time. Horvath said children today appear to lag behind previous generations in areas such as attention span, memory, literacy, numeracy, and executive function, despite spending more time in formal education.

Kamath noted that his son studies at a school where digital devices are not permitted, and screen use at home is restricted to 30 minutes a day. Despite these limits, the billionaire entrepreneur pointed out how quickly children become drawn to short-form digital content.

"At Kiaan's (son's) school, no digital device is allowed, and at home, we restrict screen time to 30 minutes a day. But even then, it is crazy, the addiction to reels/clips; I normally catch him browsing through that," the billionaire entrepreneur said.

Horvath said children today appear to lag behind previous generations in areas such as attention span, memory, literacy, numeracy, and executive function, despite spending more time in formal education.

Long Screen Exposure Can Impact Vision, Brain Development

Dr Sriram Simakurthy, Chief Medical Officer, Sankara Eye Hospital, Hyderabad, flagged the risk of excessive screen exposure in children with eye health.

“Children can develop particular vulnerabilities because they spend extended periods using screens without taking breaks, and they struggle to identify their symptoms before they become serious. Children who spend extended time looking at screens will face an increased risk of developing myopia (near-sightedness),” the expert said.

Prolonged screen exposure causes people to blink less frequently, which leads to unstable tear film production that results in dry eyes and eye irritation.

Dr. Sreenath S Manikanti, Clinical Director & Senior Consultant - Neonatology and Pediatrics, Rainbow Children’s Hospital, said that kids' eye health gets harmed by excessive screen exposure through mechanisms that extend beyond digital eye strain.

Also read: Can 'Eye Strain' Lead To Brain Cancer? Experts Explain

“The extended periods of near-focus work, which include watching screens for too long, create a permanent requirement on the eye to focus, which leads to visual fatigue and alters normal eye development in children. The period of visual system development happens throughout children's growing years,” the expert said.

Dr. B K Madhusudhan, Lead Consultant – Neurology, Aster RV Hospital, Bengaluru, noted the impact of screen time on brain development.

“The brain development process in children gets disrupted when they spend too much time using screens because that time replaces their necessary developmental activities. The continuous use of screens results in decreased attention spans, which makes it difficult for children to maintain focus during extended periods and to complete tasks that require their full attention,” Dr Madhusudhan said.

When screen time replaces parent-child conversations, storytelling, and peer interactions, this change impacts language and communication development. These experiences help children develop vocabulary skills and reasoning abilities as well as social understanding.

“Some children also develop impulsive behavior patterns and struggle with emotional control and information processing because they spend excessive time using screens,” Dr. Madhusudhan said.

How To Prevent?

The experts advised people to balance their screen use with outdoor time.

• Take breaks following the 20-20-20 rule
• Keep a proper viewing distance
• Schedule eye examinations for children at regular intervals.