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

As oncologists, we often meet patients at some of the most difficult moments of their lives. Yet there are times where a patient's journey reminds of the extraordinary resilience that people can show while facing the challenges that cancer presents

I recently treated a 38-year-old woman whose story has stayed with me.

Having just welcomed her baby into the world, her demanding yet joyful routine revolved around feeding schedules and sleepless nights. It was during this period that she noticed a hard lump in her breast.

Breast Lumps Can Cause Aggressive Breast Cancer

A sonomammography revealed a suspicious BIRADS 4A lesion. A biopsy confirmed Triple-Negative Breast Cancer (TNBC), which is one of the more aggressive forms of breast cancer. It was classified as a Stage III disease after evaluation through PET-CT which showed involvement of the axillary lymph nodes. The tumor also had a high Ki-67 index, indicating that it was growing rapidly.

Facing Cancer While Caring for A Newborn

The untimely diagnosis found the mother facing difficult questions about cancer treatment, her future and her ability to care for her child. One of the immediate challenges was that she had to stop breastfeeding.

Under the guidance of her pediatrician, her baby was transitioned to bottle feeds. This can be an emotionally challenging process for mothers as the feeling of guilt tends to seep in when breastfeeding plans are disrupted by illness.

A Modern Treatment Approach

After detailed and prolonged discussions with the patient and her family, we initiated treatment with neoadjuvant immunotherapy using pembrolizumab in combination with chemotherapy. This approach has emerged as one of the more prominent advances in the treatment of high-risk Triple-Negative Breast Cancer, having significantly improved outcomes for many patients.

Motherhood is a physically and emotionally taxing experience but the patient showed incredible strength during her cancer therapy, driven by her child and the unwavering support of her family.

Following completion of neoadjuvant therapy, repeat PET-CT imaging showed a near-complete response. She subsequently underwent surgery, and the final pathology report revealed a pathological complete response, meaning no residual invasive cancer had been detected.

This was the desired outcome for the treating team as well as the patient. She later completed the remaining course of immunotherapy, bringing her total treatment duration to one year. Today, both mother and child are doing well.

Breast Cancer Can Occur During Pregnancy

This tremendous journey highlights an important message. The fact that breast cancer can occur during pregnancy and the postpartum period deserves wider attention. Any breast lump that persists or feels unusual should be evaluated by a healthcare professional, as early diagnosis remains one of the most important factors in achieving positive outcomes.

The process is reflective of the advances in cancer treatment that are changing the outlook for patients with aggressive cancers. These advances are done through the integration of immunotherapy into treatment protocols which is helping more patients achieve improved long-term outcomes. The mother’s story is a reminder that cancer and motherhood are not mutually exclusive journeys.

Her ability to navigate this path is due to her timely diagnosis, access to appropriate treatment, family support and personal resilience. What began as a frightening diagnosis soon after childbirth ultimately became a story of hope, courage and survival. This is a powerful reminder to every new mother who might discover an unusual breast lump, that listening to your body and seeking medical advice early can make all the difference.

Pregnancy should not be regarded as a physical journey since it is a very emotional and deeply transformative phase in any woman's life. As the body changes itself to support new life, expecting mothers usually experience pain in the back, fatigue, and breathing-related discomfort. When practised under proper medical guidance, prenatal yoga can be very safe and highly supportive throughout pregnancy.

Supports Better Flexibility and Body Balance

As pregnancy progresses, the center of gravity of the body is shifted by the growing uterus. This can even impact posture and overall movement of the body. Prenatal Yoga normally includes gentle stretches and a controlled level of movement, which helps to improve the flexibility and stability without even placing unnecessary strain on the mother's and baby's bodies.

Yoga helps in:

• Reducing pregnancy-related back pain: Pain in the lower back is one of the most common discomforts that is mainly experienced during pregnancy. Gentle Yoga also assists in strengthening the back and provides better support to the spine.

• Improving breathing and oxygen flow: Mindful breathing also assists expectant mothers in managing breathlessness and calming the nervous system. Breathing-related awareness can assist women in remaining composed during the birth of a child.

• Reducing stress and anxiety: Pregnancy also causes emotional problems due to changes in hormones and physical discomfort during the birth of a child. Prenatal yoga integrates movement, exercises related to breathing, and relaxation techniques, which help reduce stress and mental fatigue. A good, calm mother is more likely to experience emotional well-being throughout the journey of pregnancy.

• Promoting better sleep: Most of the pregnant women also struggle with sleep-related patterns, due to body aches, frequent urination, which may help women to feel more confident and well prepared for the birth of a child.

• Preparing the body for labor: Prenatal yoga also plays a good role in building strength and controlled breathing, which can support the body during labor. Gentle hip opening movements and all relaxation techniques also help women to feel more confident and well prepared for the birth of a child.

• Encourages mother-baby connection: Prenatal yoga also provides expecting mothers with dedicated time to connect well with their baby. All these practices can also enhance the existing bond between mother and child, making the journey of pregnancy feel more positive.

India’s Union Ministry of Health and Family Welfare has issued a notification ending the over-the-counter (OTC) sale of all syrups, including cough syrups.

Under the new rules, a doctor's prescription will now be required to purchase cough syrups across the country.

“Consequently, the sale and dispensing of cough syrups in smaller villages will now be required to take place only through duly licensed pharmacies in accordance with the provisions of the Drugs and Cosmetics Act, 1940 and the Rules framed thereunder,” the notification said.

Why Are the Rules Being Amended?

The amendment comes months after contaminated cough syrups were linked to the deaths of 22 children in Madhya Pradesh and Rajasthan, raising fresh concerns over the safety and regulation of commonly used liquid medicines.

Following the incident last year, health authorities in India had banned three cough syrups Coldrif, Respifresh TR and ReLife after traces of diethylene glycol (DEG) were detected in the products. The Coldrif contamination was linked to the deaths of 22 children in the country.

“The amendment has been undertaken to strengthen regulatory oversight of syrup formulations and to align the exemption framework with contemporary public health and safety requirements,” the notification said.

“The measure is expected to promote responsible distribution and sale of cough syrups while ensuring greater compliance with regulatory standards across the country,” it added.

Also read: Introducing Eggs Before Age One May Lower Allergy Risk by 17%, Says Study

Experts Welcome Move To Restrict Cough Syrup Sales

Dr Kuldeep Kumar Grover, Associate Director, Pulmonology and Critical Care, CK Birla Hospital, Gurugram called it a

"a good initiative to include all syrup varieties, cough syrups included, under prescription medicines".

Cough syrups have substances that might lead to drowsiness, addiction, or drug interaction in patients who do not seek medical advice before taking the medicines.

"It is important to note that a cough could be a symptom of other serious conditions like infections, asthma, and allergies. Prescription-based access encourages proper evaluation, accurate treatment, and safer medication use," Grover said.

Dr. (Prof.) Mohsin Wali, former Physician to the President of India, said cough syrups and similar formulations often contain suppressants such as codeine and dextromethorphan (DXM), along with other solvents.

Dr. Wali, Senior Consultant and Head of Preventive Cardiology at Pacific One Health, recalled previous incidents in which contaminated Indian-made cough syrups were linked to deaths in Gambia and other African countries.

"Industrial-grade solvents were detected in some of these products, leading to kidney failure, severe metabolic acidosis, and, in some cases, death," he said.

According to Dr. Wali, the new notification will help curb the overuse, misuse, and addictive use of cough syrups while improving patient safety.

What Did The Notification Say?

The Ministry notified an amendment to the Drugs Rules, 1945, through Gazette Notification G.S.R. 927(E) dated December 29, 2025, published in the Gazette of India Extraordinary, Part II, Section 3, Sub-section (i), dated December 30, 2025.

The amendment omits the word “Syrup” from Schedule K, Serial No. 13, Entry 7 under the heading “Class of Drugs.”

Schedule K of the Drugs Rules, 1945, provides exemptions from certain provisions of the Drugs and Cosmetics Act, 1940, and the rules framed under it for specified classes of drugs.

Before this amendment, Entry No. 13 of Schedule K permitted the sale of cough syrups in villages with a population of less than 1,000 without requiring compliance with certain retail sale licensing provisions.

With the omission of the word “Syrup” from the entry, this exemption will no longer apply to cough syrups.

Manufacturers, distributors, and retailers dealing with cough syrups have been advised to ensure strict compliance with the applicable licensing and regulatory requirements under the Drugs and Cosmetics Act, 1940, and the Drugs Rules, 1945.

Ban On Pediatric Cough Syrups

Last year, India formally prohibited the use of certain commonly available OTC cough and cold medicines in children below the age of four.

The policy move, notified through a gazette notification, banned a fixed-dose combination (FDC) of Chlorpheniramine Maleate and Phenylephrine Hydrochloride—two ingredients commonly found in pediatric cough syrups.

The decision followed growing global concerns over the safety of these medicines in very young children, with India joining several countries that have introduced stricter regulations.

Countries including the United States, Canada, and the United Kingdom had previously issued guidelines or warnings regarding the use of OTC cough and cold medicines in young children.