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

Repeated miscarriages can cause stress and anxiety in couples who are searching for answers. Hence, understanding the possible causes, getting timely investigations, and following the right treatment roadmap can help improve the chances of a healthy pregnancy in the future.

Experiencing a miscarriage can be heartbreaking, but repeated miscarriages can feel even more overwhelming for couples trying to build a family. Many people believe pregnancy loss is simply due to bad luck or stress, but recurrent miscarriages often need proper medical evaluation to identify the underlying cause.

Couples tend to avoid seeking help for repeated miscarriages and keep blaming each other. However, with the help of awareness, timely testing, and the right support, many couples can go on to have successful pregnancies.

What Is Recurrent Pregnancy Loss?

Repeated miscarriage, also called recurrent pregnancy loss, refers to two or more consecutive pregnancy losses. While not every case has a clear explanation, several medical, genetic, hormonal, and lifestyle-related factors may contribute to repeated pregnancy failure.

Hence, couples will have to consult a fertility expert who will help them understand the causes behind the repeated miscarriages.

Why Medical Evaluation Is Important

The roadmap to finding answers: So, the repeated miscarriage will need a detailed medical evaluation of both partners. The expert will review previous pregnancy history, medical conditions, family history, lifestyle habits, and past test results. This helps identify possible patterns or hidden health concerns.

• Genetic testing may be advised because chromosome-related problems in either partner can increase the risk of miscarriage.

• Hormonal issues such as thyroid disorders, uncontrolled diabetes, or hormonal imbalance can also affect pregnancy health.

• In some women, structural problems in the uterus, such as fibroids, polyps, scar tissue, or an abnormal uterine shape, may interfere with implantation or fetal growth.

• Blood clotting disorders and immune-related conditions can also increase the risk of pregnancy loss.

Lifestyle Factors Matter Too

Smoking, alcohol, obesity, poor sleep, stress, and unhealthy eating habits may negatively affect fertility and pregnancy outcomes. Age can also influence egg quality and increase the chances of miscarriage.

Couples must seek timely help for repeated miscarriages, maintain an optimum weight, quit smoking and alcohol, and eat a balanced diet. Stay stress-free by doing yoga and meditation.

Exercise on a daily basis as advised by the expert, go for regular health check-ups and follow-ups with the doctor. Take prescribed supplements such as folic acid regularly. Follow these crucial tips, and it is possible to conceive even after facing repeated miscarriage.

India’s Ministry of Health and Family Welfare (MoHFW) has released the National Family Health Survey-6 (NFHS-6), showing major improvements in maternal healthcare, nutrition, immunization, and family planning across the country.

The nationwide survey, which covered nearly 6.79 lakh households across 715 districts, highlighted stronger healthcare access and improved outcomes for women and children in the country.

Key Findings of NFHS-6

The NFHS-6 was conducted during 2023-24 by MoHFW with the International Institute for Population Sciences (IIPS), Mumbai as the nodal agency.

Maternal Care

NFHS-6 recorded notable gains in maternal and child healthcare services nationwide. Nearly 96 per cent of pregnant women received antenatal care (ANC), while mothers receiving ANC during the first trimester increased from 70.0 per cent to 76.2 per cent.

The percentage of mothers receiving at least four ANC visits also rose from 58.5 per cent to 65.2 per cent, reflecting improved continuity of maternal healthcare services.

Institutional deliveries increased from 88.6 per cent to 90.6 per cent, bringing India closer to universal institutional delivery coverage.

Maternal nutrition indicators also improved significantly. Women consuming iron folic acid supplements for 100 days or more during pregnancy increased from 44.1 per cent to 54.9 per cent. Those consuming supplements for 180 days or more rose from 26.0 per cent to 37.8 per cent.

Family Planning

India’s Total Fertility Rate (TFR) remained stable at 2.0, while the Contraceptive Prevalence Rate (CPR) increased from 66.7 per cent to 69.1 per cent.

The findings reflect improved access to family planning services and the continued impact of government programs, including Mission Parivar Vikas.

Child Immunization

India also recorded progress towards universal immunization coverage. Full vaccination coverage among children aged 12-23 months increased from 83.8 per cent to 87.1 per cent based on vaccination cards.

More than 95 per cent of children received vaccinations through public health facilities, highlighting continued trust in the public healthcare system.

Coverage of major vaccines improved significantly. Rotavirus vaccination coverage surged from 36.4 per cent to 85.4 per cent, while coverage of the second dose of measles-containing vaccine increased from 58.6 per cent to 71.8 per cent.

The survey also found improvement in child health indicators. Symptoms of acute respiratory infection (ARI) among children declined from 2.8 per cent to 1.9 per cent, while severe diarrhea prevalence fell to 0.5 per cent.

The gains were attributed to stronger last-mile healthcare delivery, improved cold chain systems, digital tracking through U-WIN, and active community participation under the Universal Immunization Program.

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Child Nutrition Outcomes

NFHS-6 also reported encouraging progress in child nutrition indicators. More than 95 per cent of children under six months were breastfed during the survey period. The percentage of children breastfed within one hour of birth increased from 41.8 per cent to 50.1 per cent.

Stunting among children under five years declined sharply from 35.5 per cent to 29.3 per cent, indicating improvement in long-term nutritional outcomes.

Severe wasting declined from 7.7 per cent to 5.2 per cent, while underweight prevalence among children under five registered a marginal decline from 32.1 per cent to 31.8 per cent.

Infant and young child feeding practices also improved. Children aged 6-8 months receiving solid or semi-solid food along with breastmilk increased from 45.9 per cent to 59.5 per cent.

The birth of a child is often filled with joy, hope, and dreams for the future. But for some families, that journey also begins with an unexpected diagnosis — Down syndrome.

According to health experts, while the news can initially feel overwhelming, understanding the condition and accessing the right support can help children with Down syndrome lead fulfilling and meaningful lives.

Down syndrome, also known as Trisomy 21, is a genetic condition caused by the presence of an extra copy of chromosome 21. Instead of the usual 46 chromosomes, individuals with Down syndrome are born with 47. This additional chromosome can affect physical growth, learning, speech, and overall development.

Speaking to HealthandMe, Neurologist Dr. Rahul Chawla from ISIC Multispeciality Hospital says families often struggle emotionally after hearing the diagnosis, but understanding that Down syndrome is a genetic condition — and not a disease — can gradually help them move toward acceptance.

He noted that children with Down syndrome may learn and develop differently, but with proper medical care, therapy, emotional support, and inclusive education, many go on to study, work, play sports, and live independently with support.

How The Condition Is Diagnosed

Dr. Sweta Singla, Consultant and Head of Movement Disorder & Neurology at Manipal Hospitals, Dwarka, explained to HealthandMe that the condition can often be identified during pregnancy through screening tests such as blood tests and ultrasounds, and confirmed through diagnostic procedures like amniocentesis. After birth, genetic testing helps confirm the diagnosis.

The experts emphasized that early intervention plays a major role in improving quality of life.

"Physiotherapy, occupational therapy, and speech therapy started during infancy can help children develop communication and motor skills more effectively," Dr. Sweta said.

The experts warned that regular medical check-ups are important because children with Down syndrome may be more prone to conditions such as congenital heart defects, thyroid disorders, hearing difficulties, and vision problems.

Every Child Is Different

Children with Down syndrome present distinctive facial features, low muscle tone, delayed developmental milestones, short stature, and mild to moderate intellectual disability. Hearing and vision problems may also occur.

However, all children with Down syndrome have their own personalities, strengths, talents, and emotions, Prof. (Dr.) Brig. Ashok Saxena, Director of Neonatology and Paediatrics at ShardaCare–Healthcity, told HealthandMe.

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"Each child with Down syndrome is different – they all have their personalities, strengths, talents, and feelings," he said, adding that while some may take longer to learn speech, movement, or social skills, many are affectionate, emotionally expressive, and socially engaging.

Dr Ashok noted that a diagnosis of Down syndrome can be a very emotional and stressful time for parents.

"It can also be frightening, confusing, and filled with a lot of questions. It is important to keep in mind, though, that a diagnosis of Down syndrome doesn't mean a child's life ends. Children with Down syndrome can live a full and happy life with a loving family and appropriate medical treatment, emotional support, early therapies, and an inclusive environment," he said.

Breaking Stigma And Building Inclusion

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Inclusive education and social acceptance are also considered essential.

The doctors noted that supportive teachers, accessible opportunities, and community awareness can help children gain confidence and independence.

Families are also encouraged to seek counselling and support groups to cope with emotional stress, fear, guilt, or social stigma that may accompany the diagnosis.

Medical professionals say that awareness around Down syndrome has improved significantly over the years, alongside advancements in healthcare and therapies that have enhanced life expectancy and quality of life.