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

Maternal vaccination with the COVID-19 vaccine during pregnancy can be effective against severe disease and hospitalization from the SARS-CoV-2 virus in babies, according to a large study.

The study, published in the journal Pediatrics, revealed that COVID vaccination during pregnancy can protect the children against hospitalization for COVID during the first six months of life.

Amid continuing COVID cases, babies under six months old continue to have one of the highest rates of hospitalization — one in five — due to the COVID virus in the US, as per a 2024 study.

As currently no vaccines against COVID are available for neonates and babies, the American College of Obstetricians and Gynecologists (ACOG) recommends maternal vaccination during pregnancy.

Maternal COVID Vaccination Prevented Other Infections

The retrospective study included 146,031 infants born in Norway between March 2021 and December 2023. Of these, 37, 013 (25 percent) were exposed to COVID-19 vaccination in utero.

The findings showed that babies exposed to the vaccine before birth were no more likely to visit the hospital for overall infections (of any kind) than those whose mothers did not get vaccinated in pregnancy.

However, infants whose mothers were vaccinated were about half as likely to visit the hospital specifically for COVID in their first two months of life compared to babies not exposed to the vaccine in utero.

Among 3 to 5-month-old babies, the risk of a hospital visit for COVID was 24 percent lower in those exposed to the vaccine, but the vaccine's protection against COVID wore off by the time infants were older than 6 months.

Importantly, the mothers' vaccine also prevented the risk of other infections in children.

"There is often an increased risk for a subsequent infection after a viral infection, such as an increased risk of pneumonia after influenza infection, so we wanted to study whether protection against COVID-19 could influence the risk of other infections as well," said lead author Dr. Helena Niemi Eide, from the University of Oslo in Norway, the NPR reported.

"But we found that COVID vaccination in pregnancy protected the infant against COVID and had no apparent effect on other infections," Eide added.

Maternal Vaccine Recommendation in the US

Last week, the American College of Obstetricians and Gynecologists reiterated its recommendation for COVID vaccination during pregnancy.

Despite changes in federal vaccine recommendations due to the US Health Secretary Robert F. Kennedy Jr.’s anti-vaccine stance, the ACOG urged COVID vaccination for

• people who are pregnant,
• recently pregnant,
• considering pregnancy,
• lactating.

Also read: US Judge Blocks RFK Jr.’s Vaccine Schedule, Says Government Ignored Science

"Accumulated safety data from millions of administered doses show no increased risk of adverse maternal, fetal, or neonatal outcomes associated with COVID-19 vaccination in pregnancy,” the ACOG said.

When 36-year-old mom Angela Sanford, from Fort Mill, SC, went for an appointment for a Pap smear five years after she had her first child in 2008, her nurse midwife, who she has never seen before asked her a question she did not expect. "Who stitched you up after your first birth?"

Speaking to Healthline, Sanford shared that she just started crying when the nurse said, "This is not right." Sanford said that this was the first time she ever heard the term 'husband stitch'. Sanford was told that her stich was "too tight" by the hospitalist who managed her after her first delivery.

Also Read: US CDC Warns Of New Immune-Evasive COVID Variant In 23 Countries

“He gave you what some people call a husband stitch,” Sanford recalled the midwife telling her.

“I couldn’t connect in my mind why it would be called that. My midwife said, ‘They think that some men find it more pleasurable,’” she recalled. “My husband has been worried about me and fearful of hurting me. He would never have asked for this.”

A 'Husband Stich' - What Is It?

During vaginal delivery, a woman undergoes perineal tears or vaginal lacerations which means tears between the vaginal opening and anus. This causes pain, and requires stitches for grades two and higher. It also takes 4 to 6 weeks to heal. Women can experience from first to fourth degree tears.

Sometimes, a surgical incision is made in the perineum during childbirth to enlarge the vaginal opening, this is called an episiotomy. However, it is not medically necessary or a routine procedure, unless it is a case of emergency.

Stiches are required in such cases that dissolves on its own. However, a 'husband stitch', also known as "daddy stitch" is an unethical practice where an extra stitch is given during the repair process that 'tightens the vagina' to increase sexual pleasure for a male partner. While it is considered a medical malpractice, it is still done to women after vaginal delivery.

Many women face difficulty after the extra stich is given to them. In Sanford's case, she felt "excruciating" pain during sex afterwards.

Read: Romanticization And The Silent Dismissal Of Women’s Pain

When Objectifying Women's Bodies Is Made A Medical Practice

Stephanie Tillman, CNM, a certified nurse midwife at the University of Illinois at Chicago and blogger at The Feminist Midwife told Healthline: “The fact that there is even a practice called the husband stitch is a perfect example of the intersection of the objectification of women’s bodies and healthcare. As much as we try to remove the sexualization of women from appropriate obstetric care, of course the patriarchy is going to find its way in there."

Harkins, 37, said that she "kind of" laughed it off when an "old, crusty Army doctor" overstitched her so she could give her husband more pleasure. In many cases, doctors do it as a routine practice without even being told by anyone. “I couldn’t even process [it], but I kind of laughed, like what else do you do when someone says that? I had just had a baby. I didn’t think much about it because the whole birth experience was so traumatizing, but now that I think about it differently, the implications of that are just crazy.”

Episiotomy Is An Excuse For 'Husband Stitch'

Dr Robert Barbieri, chair of obstetrics and gynecology and reproductive biology at Brigham and Women’s Hospital in Boston, told the Huffington Post that doctors were taught in the 50s and 60s that "routine episiotomy was good for women".

“What they thought is that if they did a routine episiotomy, they’d have a chance to repair it and that during the repair, they could actually create a better perineum than if they hadn’t done it. The idea [was] that we could ‘tighten things up,’” explains doctor.

However, a 2005 systematic review in the Journal of the American Medical Association found no benefit to routine episiotomy use. A 2017 Cochrane review “could not identify any benefits of routine episiotomy for the baby or the mother.” In 2016, the American College of Obstetricians and Gynecologists (ACOG) recommended that clinicians “prevent and manage” delivery lacerations through strategies like massage and warm compresses rather than making cuts on the perineum. Yet, this practice still continues inside the labor rooms.

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.