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

Vitamins and minerals are often consumed for better health and immunity, but a new US study is drawing focus to a danger that may get overlooked. The danger is toxicity if vitamins and minerals are ingested in excessive quantity, particularly for children.

Researchers found that 1,961 children were hospitalised for vitamin and mineral toxicity over a three-year period, according to findings presented at the Pediatric Hospital Medicine 2026 meeting in Kansas City, Missouri.

The researchers used data from the federal Healthcare Cost and Utilization Project Kids’ Inpatient Database, which captures hospital admissions involving children across the US.

But the figure may represent only a part of the problem. “Our study probably only scratched the surface,” lead researcher Marina Masciale, MD, MPH, of Baylor College of Medicine, said while presenting the findings.

Most Poisoning Cases Were Due To Intentional Ingesting

One of the most interesting findings was that the majority of hospital admissions due to vitamin and mineral toxicity was due to intentional ingestion.

That makes the issue different from a child accidentally swallowing one or two tablets. Researchers say the findings highlight the need to consider supplements when assessing children who may deliberately ingest potentially harmful substances.

The database also captured only supplements for which there was a specific toxicity-related ICD-10 diagnostic code. This means poisonings involving supplements that were not coded in this way may not have been included. As a result, the researchers believe the true number of affected children could be substantially higher.

Also read: Is Your Child Suddenly Sluggish, Clumsy? Signs Of Juvenile Arthritis Parents Miss

Why Are Children Getting Poisoned If Vitamins Are Supposed To Be Safe?

The body requires many micronutrients in relatively small quantities. Some can become harmful when taken in excessive amounts, particularly certain fat-soluble vitamins that can accumulate in the body.

Minerals can also cause toxicity when consumed in excessive quantities. The symptoms and severity depend on the substance, dose and how quickly treatment is provided.

This is why supplements should not be popped like harmless candies simply because they are sold over the counter.

Also read: Too Much Cow’s Milk Linked To Severe Iron Deficiency In Toddlers, Including Three Deaths

Why Children Are Particularly Vulnerable?

Many supplements also come in colourful, flavoured or chewable forms, making them particularly attractive to younger children.

But the new findings highlight another concern: older children and adolescents may deliberately consume large quantities of supplements, meaning prevention cannot rely only on keeping bottles out of reach.

Parents and caregivers should therefore store vitamins, minerals and other supplements securely and treat them like medicines rather than everyday food products.

What Should Parents If They Suspect An Overdose?

If a child may have swallowed a large amount of vitamins or minerals, parents must not wait for symptoms to appear.

The exact risk depends on what was taken, how much was consumed and the child’s age and weight. Some toxic effects may not be immediately evident.

Medical professionals may need information from the supplement label, including the ingredients and strength, to determine the appropriate treatment course.

Arthritis is often associated with ageing, but it can also affect children. The most common form of chronic arthritis in children under 16, including those as young as 1, is Juvenile Idiopathic Arthritis (JIA).

Because its early symptoms can be subtle, JIA often goes unrecognized, delaying diagnosis and increasing the risk of joint and growth-plate damage.

Children May Not Say They Are In Pain

Young children may not know how to describe joint pain. Instead, they may change their behavior to avoid discomfort, making it important for parents to notice changes in movement and activity.

A toddler may limp, take longer to get ready or become less active, Dr. Rashmi Jinnakeri, Consultant Pediatrician, Apollo Hospital, Bengaluru, told HealthandMe. These signs may be mistaken for a viral infection, growing pains or simple clumsiness.

Also read: Too Much Cow’s Milk Linked To Severe Iron Deficiency In Toddlers, Including Three Deaths

Signs Parents Should Watch For

Unlike an injury, JIA symptoms tend to persist, Dr. Chirag Rajkumar Kopp, Consultant – Clinical Immunology & Rheumatology, Ramaiah Memorial Hospital, told HealthandMe.

Parents should watch for:

• Joint pain or swelling lasting more than six weeks
• Morning stiffness that improves during the day
• Neck or lower back pain with stiffness
• An unexplained limp
• Recurrent fever without an obvious cause
• Skin rashes
• Red eyes or sensitivity to light

Morning sluggishness:

A child who normally wakes up energetic may suddenly take much longer to get out of bed, get dressed or start moving. Similar stiffness or sluggishness may occur after an afternoon nap. This can be one of the more subtle signs of JIA in young children.

Sudden clumsiness:

Parents may notice a child dropping objects, tripping, coloring messily or struggling with buttons and zips. Subtle limping after waking may also occur and can improve as the day progresses.

Avoiding play and physical activity:

Children may begin avoiding sports, physical education or activities they once enjoyed. A child who previously loved running and jumping may increasingly prefer to sit or find reasons not to participate.

Going back on milestones:

Some toddlers may show regression in movement. A child who was walking may start crawling again or frequently ask to be carried. Mild swelling, particularly around a knee, can also be overlooked. If only one joint is affected, parents may assume the child bumped it while playing.

Fatigue, fever and rashes:

Some children may appear unusually tired, have low energy or repeatedly say they cannot walk. Fleeting rashes with fever may be mistaken for viral infections. Repeated low- or high-grade fever without cough, cold or vomiting can also occur.

Read More: 'Let's Fix Our Food': India Launches New Policy To Fight Childhood Obesity, Boost Nutrition

Growing Pains vs Juvenile Arthritis?

Children may describe both conditions simply as “leg pain”, making the distinction difficult, Dr. Rashmi said.

Growing Pains

• Usually occur later in the day after physical activity
• Often affect the thighs, calves or shins
• May improve with massage
• Do not cause joint swelling or redness
• Are usually gone by morning

Juvenile Arthritis

• Is often worse in the morning
• Causes joint-related pain and stiffness
• May cause swelling or redness
• Can improve with movement
• Persists over time, potentially for six weeks or longer

Early Diagnosis Matters

JIA occurs when the immune system mistakenly attacks healthy joints, causing inflammation. The exact cause is not known.

“When this goes unrecognized for too long, the effects don't simply fade with time. Joint damage can become permanent; a child's growth can be affected, and the disability that follows may last well into adulthood,” Dr. Chirag said.

Early treatment with disease-modifying antirheumatic drugs (DMARDs) and, when needed, biologic therapy can control inflammation and help prevent lasting damage. With early recognition and treatment, most children can achieve symptom control and continue to run, play and grow without limitation.

A blood test is considered the first step towards fertility enquiries, but for many, the results might seem like a confusing jumble of numbers and acronyms. Reports sometimes contain terms like AMH, FSH, LH, AFC, and estradiol, which can confuse patients into thinking that a single "abnormal" figure indicates they are unable to conceive.

The truth is more reassuring, and more nuanced. Fertility experts stress that a single test cannot ascertain a person's fertility. Instead, these markers serve as parts of a bigger picture, assisting fertility specialists in comprehending reproductive health and suggesting the best course of action when necessary.

Fertility tests are guides, not verdicts

The idea that a single blood test can determine whether a woman would naturally become pregnant is one of the most widespread myths. Age, egg quality, ovulation, sperm health, uterine health, lifestyle, and underlying medical issues are some of the factors that actually affect fertility.

Although diagnostic markers offer useful information, they must always be interpreted in conjunction with the couple's overall reproductive profile, clinical history, and ultrasound results.

Understanding the ovarian reserve 'AMH'

Anti-Müllerian Hormone (AMH) is perhaps the most talked-about fertility marker today. It is produced by small follicles present in the ovaries. AMH reflects ovarian reserve, which identifies the estimated number of eggs remaining in the ovaries. High AMH indicates larger ovarian reserve, whereas lower levels suggest fewer eggs. However, it can neither measure egg quality nor guarantee the ability to conceive naturally.

Many women with low AMH can still achieve successful pregnancies, especially if they continue to ovulate regularly. Similarly, women with high AMH are not necessarily more fertile; elevated AMH levels in women also mean Polycystic Ovary Syndrome (PCOS), where ovulation may actually be irregular. For fertility specialists, AMH is useful in predicting the number of eggs that are likely to respond to ovarian stimulation medication, based on which they customize IVF treatment.

FSH determines ovarian function

Our pituitary gland produces Follicle Stimulating Hormone (FSH), and this hormone helps in stimulating egg development.

Usually, the second or third day of the menstrual cycle is when FSH is measured. If ovarian reserve is reduced, higher-than-normal levels may imply that ovaries need more stimulation to mature eggs. From cycle to cycle, the FSH levels change.

LH and the ovulation story

FSH and luteinizing hormone (LH) cooperate to control ovulation. The ovary releases a developed egg in response to an increase in LH. LH levels may be disproportionately greater than FSH in PCOS-affected individuals, which can lead to irregular menstrual periods and ovulation. Instead of using LH alone, fertility specialists assess it in link with other hormone markers.

Estradiol and AFC: Completing the picture

An indicator of ovarian activity during the menstrual cycle is estradiol (E2), a type of estrogen generated by growing follicles. Combined interpretation is crucial since elevated early-cycle estradiol levels can occasionally conceal an elevated FSH.

The Antral Follicle Count (AFC), which is done via a transvaginal ultrasound, is another crucial evaluation. AFC gives an additional indication of ovarian reserve by counting the number of visible tiny follicles in the ovaries.

Indeed, the combination of AMH and AFC provides a more thorough insight than any test by itself.

Fertility evaluation isn't just for women

Female hormone testing frequently receives greater attention, whereas male fertility contributes to roughly half of all infertility issues. A semen screening remains one of the most significant and cost-effective tests, measuring sperm count, mobility, and morphology. When necessary, additional hormonal or genetic tests might be suggested.

Era of self-diagnosis

After getting a test report, many people search the web for quick answers, but those numbers without proper medical context from a specialist can cause unnecessary tension. The fertility markers depend on a variety of factors, some of which include: age, weight, menstrual history, prior pregnancies, medications, hormonal status, and lifestyle. Therefore, understanding parameters like “low” or “high” online may create confusion for individuals. Instead, consult a fertility specialist to decode the report.

(Dr Rubeena Zainab, Senior Consultant - Reproductive Medicine, Milann Fertility and Birthing Hospital, Bengaluru)