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

Nearly 76,805 children and adolescents in India are estimated to develop cancer each year. At the same time, childhood cancer can be highly treatable when diagnosed early and managed appropriately, with survival exceeding 80% in settings where timely diagnosis and comprehensive treatment are available.

When people think about preventive healthcare for children, the conversation usually centers on vaccinations, good nutrition, physical activity, sleep and regular health check-ups. These are important for a child’s overall health. But prevention also involves something that is often overlooked: recognizing when a child’s health is changing and seeking medical advice at the right time.

Childhood cancer is different from many cancers seen in adults. In most cases, there is no clear lifestyle-related cause that parents could have avoided. A child developing cancer is therefore not usually linked to something the parents did or did not do. This is important because there is no particular diet, exercise routine or supplement that can guarantee protection against childhood cancer.

The Importance of Recognizing a Pattern

For doctors, one of the more practical ways to improve outcomes is to recognize when a seemingly common symptom is not following its usual course. Fever, tiredness, headaches, loss of appetite or body pain are frequent childhood complaints. But when they persist, keep returning or occur alongside other changes, they should not simply be treated repeatedly without evaluation.

• Unexplained weight loss

• Unusual bruising or bleeding

• Persistent bone or abdominal pain

• A growing lump or swelling

• Repeated headaches

• Changes in vision

These are some signs that may require further assessment. These symptoms are not specific to cancer, but their persistence warrants attention.

Why Early Diagnosis Matters

Most childhood cancers do not have a routine screening test for healthy children. Diagnosis therefore often depends on noticing an unusual pattern and investigating it appropriately.

A delay does not necessarily mean that cancer has been missed, but prolonged delays can allow some cancers to progress before treatment begins. For this reason, awareness among parents and healthcare providers, timely evaluation and appropriate referral are important parts of childhood cancer care.

Prevention Is Not Just About Avoiding Cancer

Vaccination still has a place in the broader cancer-prevention conversation. Hepatitis B vaccination helps reduce the risk of liver cancer linked to chronic hepatitis B infection, while HPV vaccination can help prevent HPV-related cancers later in life. However, these vaccines do not prevent most cancers that occur during childhood.

Similarly, nutrition should be viewed in the right context. A balanced diet supports growth and recovery, including during cancer treatment, but there is no specific food or diet that can prevent a cancer.

The Cost of Childhood Cancer

Childhood cancer can place a significant financial and practical burden on families. Treatment costs may be accompanied by expenses related to travel, accommodation, food and time away from work.

At the same time, families today have more avenues of support than before. Government health schemes, public healthcare facilities and non-government organizations can help with treatment costs and other practical needs. The challenge is ensuring that families are aware of these resources and can access them early enough.

Looking Beyond Treatment

Children who survive cancer may need long-term monitoring for possible effects of treatment on growth, development and other aspects of health.

For childhood cancer, therefore, prevention is less about finding a way to eliminate risk and more about reducing what can be changed: delayed diagnosis, interruptions in treatment and avoidable long-term complications..

(Dr Amita Mahajan, Senior Consultant, Pediatric Oncology, Indraprastha Apollo Hospital, Delhi)

A baby's first protection against serious infections begins even before birth. Timely maternal vaccination during pregnancy helps pass protective antibodies from mother to baby, offering valuable immunity during the first few months of life.

Many parents believe that a baby's vaccination journey starts only after birth. However, doctors say a baby's first protection actually begins during pregnancy. During the third trimester, a mother's body naturally passes protective antibodies to her baby through the placenta.

These antibodies help protect newborns from certain infections during the first few months of life, when their immune system is still developing and before their own vaccines provide full protection. Maternal immunisation not only protects the mother from serious illnesses during pregnancy but also gives the baby a healthy start. Yet, many expectant mothers are aware only of the tetanus-containing vaccine (Td) and may not know about other important vaccines or health checks that can benefit both mother and child.

How does a baby get protection before birth?

During pregnancy, especially in the last three months, antibodies produced by the mother's immune system cross the placenta and enter the baby's bloodstream. These antibodies act as the baby's first line of defence after birth.

Since newborn babies have immature immune systems, this natural transfer of immunity helps lower the risk of severe infections during the early weeks and months of life. This protection is temporary, which is why babies still need to receive all their routine childhood vaccinations on time after birth.

Also read: Trying For A Baby? Tobacco Smoking Hurting Male And Female Fertility, Warns WHO

Which vaccines are important during pregnancy?

Doctors commonly recommend the Td (Tetanus and Diphtheria) vaccine during pregnancy to protect both the mother and baby from tetanus. Depending on the mother's medical condition, vaccination history, and local recommendations, doctors may also advise the Tdap vaccine, which protects against tetanus, diphtheria, and whooping cough (pertussis).

In some situations, the influenza (flu) vaccine may also be recommended, particularly during flu season or for women at higher risk of complications. Another important step is rubella screening before pregnancy. Rubella infection during early pregnancy can lead to serious birth defects. Women planning pregnancy should ensure they are protected against rubella before conceiving, as the vaccine is not given during pregnancy.

Also read: Are Children Breathing Clean Air Inside Classrooms? New European Study Raises Concern

Why maternal vaccination matters?

Vaccination during pregnancy helps reduce the mother's risk of certain infections, lowering the chances of illness-related complications during pregnancy. At the same time, it allows protective antibodies to reach the baby before birth, providing valuable immunity until the infant begins receiving routine childhood vaccines.

Discuss vaccination early during antenatal visits so that recommended vaccines can be given at the appropriate time. Every pregnancy is unique, and vaccination decisions should always be made in consultation with the doctor.

Tips for expectant mothers

• Discuss recommended vaccines during your very first antenatal visit.

• Receive the Td vaccine as advised by your doctor.

• Ask your doctor whether the Tdap vaccine is recommended in your pregnancy.

• If advised, get the influenza vaccine during pregnancy.

• If planning a pregnancy, get screened for rubella immunity and complete vaccination before conception if needed.

• Attend all regular prenatal check-ups.

• Follow a healthy diet, stay physically active as advised, and get adequate rest.

• Continue your baby's routine vaccination schedule after birth without delay.

By discussing immunisation early in pregnancy and following medical advice, parents can give their newborn an important layer of protection even before the first cry.

Globally, one in six people of reproductive age experiences infertility at some point in their lifetime. Smoking is one of the key reasons for infertility among men and women worldwide, according to a new World Health Organization (WHO) knowledge summary.

The report, the 12th in a series of Tobacco Knowledge Summaries, highlights evidence linking tobacco use to infertility in women, harmful effects on sperm and sexual function in men, and potentially lower chances of success with some fertility treatments. It also warns that second-hand smoke may affect reproductive health.

Infertility is defined as the failure to achieve pregnancy after 12 months or more of regular unprotected sex.

What Does the WHO Report Say?

Infertility can have multiple causes. However, cigarette smoking and exposure to second-hand tobacco smoke are associated with infertility in women.

The harmful effects of cigarette smoking on women’s reproductive health are well documented, while evidence on other tobacco products, including waterpipe and smokeless tobacco, as well as nicotine products such as e-cigarettes, is still emerging.

Current data suggest potential risks to fertility, but further research is needed to fully understand these effects. Among

men, cigarette smoking is associated with harmful effects on semen and sperm, as well as sexual function, which can contribute to infertility.

On the other hand, women who quit smoking may have a lower risk of infertility compared with women who continue to smoke.

WHO recommends that healthcare providers inform individuals and couples planning pregnancy about the reproductive risks of tobacco use and offer evidence-based support to help them quit.

How Smoking Affects Fertility?

“Smoking is an important fertility consideration for both men and women. It can affect the quality of both eggs and sperm, and the concern is not limited to people who smoke themselves,” Dr Neelam Suri, Senior Consultant, Obstetrics & Gynecology, Indraprastha Apollo Hospital, Delhi, told HealthandMe.

Smoking also accelerates follicular depletion, which may contribute to an earlier onset of menopause compared with women who do not smoke.

Second-hand smoke can expose individuals to harmful substances that may affect reproductive health. Eggs and sperm are rapidly developing cells, and exposure to tobacco smoke can increase the risk of DNA damage and other cellular changes that may affect fertility and reproductive outcomes.

Dr Shalu , Senior Clinical Director, Cloudnine Group of Hospitals, Gurugram, told HealthandMe that while passive smoking may not directly cause infertility in every individual, regular exposure to tobacco smoke can affect reproductive health and have significant implications during pregnancy.

These include ectopic pregnancy, miscarriage, preterm birth, pre-eclampsia, fetal growth restriction, low birth weight, stillbirth, placental complications and neonatal complications.

Regular exposure to second-hand smoke may also potentially influence the chances of success with fertility treatments such as IVF.

“This is particularly relevant for couples undergoing IVF, where egg and sperm quality can influence the chances of successful treatment,” Dr Suri said.

What Should Couples Planning Pregnancy Do?

For couples planning a pregnancy or undergoing fertility treatment, avoiding tobacco smoke is an important step towards protecting reproductive health.

This means quitting smoking and maintaining a smoke-free environment at home to reduce regular exposure to cigarette smoke.

At the same time, fertility depends on multiple factors. Exposure to second-hand smoke does not necessarily mean a couple will experience infertility or IVF failure. However, reducing preventable risk factors can be beneficial when trying to conceive.

Ideally, couples should create a smoke-free environment before conception rather than waiting until fertility difficulties emerge.