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) 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.

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.

We are all aware of the fact that the use of plastics causes harm to our environment, and dangerously so. But what will happen when we realize that plastic can enter our bodies too?

As far as gynecological reproductive health is concerned, the major emphasis has always been on genetic aspects, hormonal imbalance, and even the choice of food and regular exercise. PCOS and endometriosis are both known to cause health concerns in women during menstruation and during or after sex. However, today there is another threat to the health of women’s reproductive organs in the form of microplastics and nanoplastics.

Can these enter the ovaries and result in greater damage to women’s sexual and reproductive health? The answer, unsurprisingly, is a yes. Microplastics, along with nanoplastics, have actually been detected in ovarian tissues and in follicular fluid.

Understanding The Invisible Intruder

To grasp the scale of this issue, one must first define the particles involved. Microplastics are tiny fragments of plastic less than five millimeters in size, while nanoplastics are less than one micrometer. These are so small that they remain invisible to the naked eye and can easily bypass the body’s natural biological barriers.

They can be identified as multiple polymers, including polyethylene (PE), polypropylene (PP), polystyrene (PS), and polyethylene terephthalate (PET), commonly used in packaging and agricultural materials. The 2024 Science of the Total Environment study, which used Py-GC/MS to confirm the presence of polymers such as polyethylene and PVC in human follicular fluid for the first time. Out of the 18 women sampled, over 80% had microplastics in their follicular fluid.

The ovaries were once thought to be a protected zone, shielded by complex filtration systems. It is now understood that these particles enter the bloodstream through food, water, and even the air we breathe. From the bloodstream, they can directly seep into the reproductive organs too. Common polymers like polyethene found in plastic bags, and polystyrene used in packaging, are now being identified in the very fluid that determines the quality and competence of a woman’s oocytes.

The Trojan Horse Effect: How Damage Occurs

From a clinical standpoint, the concern is not just the presence of the plastic itself, but the Trojan Horse effect it creates. These particles often carry Endocrine Disrupting Chemicals (EDCs). When these particles lodge themselves in ovarian tissue, they trigger several harmful processes:

• Oxidative Stress and Cellular Ageing – The presence of a foreign object in the ovary triggers the production of Reactive Oxygen Species (highly reactive molecules derived from oxygen). This is a form of cellular rusting as oxidative stress can damage the DNA of the oocytes and potentially cause poor maturation and a decline in overall egg quality at an early stage of their life.
• Hormonal Mimicry – Most plastics contain chemicals that mimic estrogen. When these enter the follicular environment, they disrupt the natural signaling of progesterone and estrogen. This can lead to irregular menstrual cycles and has been linked to conditions such as Polycystic Ovary Syndrome (PCOS).
• Mitochondrial Dysfunction – Nanoplastics are particularly invasive because they can penetrate cell membranes. Once inside, they can disrupt the mitochondria, which are known as the cell’s powerhouses. Since an egg cell requires an immense amount of energy to develop and eventually fertilize, any disruption to energy production can compromise fertility. Also, plastic is eternal; it's very difficult for the human body to dissolve it and remove it from the body.

From Environment To Egg: The Journey Of Exposure

It is important to recognize that this is a cumulative issue. Human beings are exposed to these particles through multiple daily touchpoints:

• Ingestion: Microplastics shed from plastic water bottles, especially when heated. They are also found in ultra-processed foods and certain seafood. We should immediately stop using plastic containers for storing food and water, and shifting towards glass containers and copper bottles can be more beneficial both for the environment and for the body. Heat is the primary catalyst that causes plastics to leach into food and water. Switching to glass, ceramic, or stainless steel is a vital step; also, using high-quality carbon or reverse osmosis filters can catch a significant percentage of micro-particles.

• Inhalation: In urban environments, people breathe in synthetic fibers from clothing and carpets. The main component of most clothing today is polyester, especially blankets and sheets, which come in direct contact with skin. Polyester can directly penetrate our body and cause immense harm.

• Dermal Contact: Some personal care products contain microbeads or plastic-based thickeners that can be absorbed through the skin. For this, we need to be very careful before purchasing our products; it is time we start reading product labels – simply flip the product and see the ingredients listed behind.

To What Extent is it Harmful?

While there is strong evidence that these plastics are present in the ovaries, researchers are still studying the long-term, population-wide effects on fertility. This is not a reason for panic, but it is a call for preventive action.

Pre-clinical models suggest that high levels of microplastics can reduce the ovarian reserve, which is the number of healthy eggs remaining with each passing year. In clinical settings, investigators are also beginning to explore whether the presence of these particles can explain why IVF treatments sometimes fail despite profiles being otherwise healthy. The evidence points to a dose-dependent risk, which means that if exposure is reduced now, it may protect future reproductive longevity.

The Path Forward: Advocacy and Awareness

This issue now sits at a critical intersection of environmental science and gynecology. There is a growing movement to go beyond viewing infertility as a purely medical issue and start seeing it as an environmental one. Furthermore, policy-level changes are needed to regulate the use of plastic in the food and beauty industries.

The presence of microplastics in the ovaries is a quiet, invisible threat, but it can be addressed through awareness and intentional living. By making small changes today, individuals are not just protecting their own health but also the biological integrity of generations to come.