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

Influenza and COVID-19 may trigger a rare but fatal brain condition in children, according to a new study published in Frontiers in Neurology.

Based on 138 reported cases of acute necrotizing encephalopathy (ANE), the research is built on 15 studies involving children under 18 diagnosed with ANE following respiratory viral infections.

ANE can cause rapid neurological deterioration, seizures and damage to deep structures of the brain, even in children who were previously healthy.

Influenza viruses accounted for 46% of the reported cases, while SARS-CoV-2, the COVID-19 virus, accounted for 42.3%. Together, they represented nearly 90% of the cases in the review.

The findings highlight the need to recognise neurological symptoms that develop after a child has a fever or respiratory infection.

However, ANE remains rare, and the study does not suggest that most children with flu or COVID-19 are at risk of developing the condition.

Flu And COVID-19 Accounted For Most Reported Cases

Influenza viruses were identified in 63 cases, while SARS-CoV-2 was identified in 58. Another 17 cases were linked to unspecified respiratory viral infections.

The findings suggest that influenza and COVID-19 are key reported triggers of ANE. However, the researchers cautioned that the studies were observations, and the findings cannot establish how often ANE develops among children infected with either virus.

Also read: Swimmer Archie Goodburn’s Plea Prompts UK Brain Cancer Research Review

What Is Acute Necrotizing Encephalopathy?

Acute necrotizing encephalopathy is a rare neurological disorder in which inflammation and tissue injury cause damage to the brain. It is mostly linked with a respiratory viral infection.

The condition is characterised by lesions in the thalami, two structures deep inside the brain that help process sensory information and regulate functions like alertness.

In some children, damage also affects the brainstem and other regions. Rather than the virus directly destroying brain tissue, an excessive inflammatory response may disrupt the blood-brain barrier, allowing inflammation to damage the brain.

Symptoms of Acute Necrotizing Encephalopathy

ANE usually starts with symptoms of the initial viral infection, like fever, cough, vomiting, and diarrhea, followed by rapid neurological decline, which may include:

• Seizures
• Confusion, drowsiness, and altered consciousness
• Coma lasting for weeks
• Problems with movement (ataxia)
• Abnormal muscle tone

One of the most concerning features of ANE is how quickly a child's condition can worsen after a febrile illness.

In the reviewed cases, fever was reported in 93.4% of children, altered consciousness in 94.9% and seizures in 68.6%. These figures describe children who had ANE, not all children with respiratory infections.

These symptoms require emergency medical assessment. Parents should not wait for a fever or other infection symptoms to resolve if a child develops seizures, confusion or reduced consciousness.

Mortality Rate Of ANE

Despite treatment, the outcomes reported in the study were serious. Of the 138 children included in the review, 54 died, giving a reported mortality proportion of 39.1%.

Survivors also experienced neurological complications, including problems affecting movement, cognition and development.

It is important to note that the study included published cases of a rare and severe disease, which may overrepresent children with particularly serious illness. It is not a population-wide estimate of the risk of death from ANE. Brain imaging like MRI can help doctors identify the characteristic lesions associated with the condition.

India's food safety regulator has proposed implementing a restriction on adding sucrose and fructose to foods for babies up to six months old. The move aims to reduce consumption of added sugars during early infancy, which is considered to be a crucial period for growth and development.

The Food Safety and Standards Authority of India (FSSAI) has published a draft amendment to the Food Safety and Standards (Foods for Infant Nutrition) Regulations, 2020. The proposal was published in the Gazette of India on October 16, 2026, and announced by the Ministry of Health and Family Welfare on October 17.

Under the proposed amendment, “sucrose and fructose shall not be added in the products intended for infants up to the age of 6 months”. The FSSAI has kept the proposal open, inviting objections and suggestions within 60 days of the Gazette copies being made available.

FSSAI's Proposal For Baby Foods

Sucrose is the most common sugar found in many baby foods, while fructose is a naturally occurring sugar found in fruits and some other foods. Both can also be used as ingredients in certain manufactured foods products.

Under the existing infant nutrition regulations, lactose and glucose polymers are the preferred carbohydrate sources. Sucrose and fructose can be added when carbohydrate sources need to be added, subject to prescribed limits.

The proposed amendment would restrict that allowance for baby foods for infants up to six months. The proposal concerns the addition of these sugars to regulated infant nutrition products.

Also read: The Silent Struggle Of Raising A Child With Mental Health Challenges: How Parents Can Cope With Stigma

Is Added Sugar A Concern In Early Infancy?

The first six months of life are important for an infant's physical growth and development. During this period, babies need nutrition that meets the requirements needed for growth, rather than ingredients added simply to increase sweetness.

FSSAI says the proposed restriction aims to ensure that infant nutrition products meet these needs without unnecessary additions of sucrose and fructose. The move is also part of a measure towards wider public health efforts to curb dietary risk factors like childhood obesity and other metabolic health problems.

The proposal, therefore, focuses on reducing unnecessary added sugars and strengthening nutritional standards for this age group.

Also read: Childhood Fitness Linked To Lower Risk Of Depression In Adulthood: 30-Year Study

Could This Improve Infant Health?

If the amendment is finalised, manufacturers will need to formulate baby food products for babies up to six months in accordance with the new restriction. The benefits of this move include:

• Reducing unnecessary added sugars: Infant nutrition products would no longer be permitted to contain added sucrose or fructose for this age group under the proposed rule.
• Supporting age-appropriate nutrition: Manufacturers would need to ensure their formulations meet infants' nutritional requirements without relying on these sugars.
• Strengthening preventive nutrition: The proposal forms part of wider efforts to promote healthier feeding practices from the earliest stages of life.

The actual health impact will depend on how the rules are implemented and the nutritional composition of the products affected.

The proposed restriction also supports established public health recommendations that promote exclusive breastfeeding during the first six months of life.

For parents who cannot breastfeed or need an alternative for medical or other reasons, an appropriate infant formula can help meet a baby's nutritional needs. Parents should consult a qualified healthcare professional about feeding choices rather than preparing homemade substitutes.

When a child struggles with mental health issues, parents may tend to find themselves dealing with more than concern about their child's well-being.

Judgement from people around them, including relatives, friends, neighbours and other parents can add guilt and shame to an already challenging experience. Some families may even withdraw socially to avoid uncomfortable questions.

A recent study promoted by News-Medical found that parents may feel judged when they feel they are not able to live up to the definition of a "good parent." The researchers interviewed 24 parents whose children had mental health challenges.

The belief that a child's behavioural difficulties reflect poor parenting makes it harder for families to seek help. Parents may be told to discipline their child more strictly or change their parenting style, even when the child needs special care.

“Stigma often hurts parents as much as the condition hurts the child,” says Dr. Anupam Madaan, Attending Consultant Psychiatrist at Fortis, Jalandhar told HealthandMe.

But parents do not have to navigate this on their own. Understanding mental health conditions, seeking timely treatment and creating a supportive home environment can help children cope with their challenges without carrying the burden of stigma.

Why Do Parents Feel Judged?

Also read: GLP-1 Drugs May Offer Mental Health Benefits, Reduce Schizophrenia Relapses: Lancet Study

"Mental health problems are still widely misunderstood," Dr. Shiv Prasad, MD Psychiatry, Professor and Head of the Department of Psychiatry at Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital told HealthandMe.

Many people assume that a child's emotional or behavioural difficulties result from poor parenting, a lack of discipline or an inadequate upbringing.

He said, "There is also a lack of awareness about mental health conditions. While people are generally more comfortable discussing physical illnesses, they may hesitate to talk about depression, anxiety, ADHD, or other mental health concerns. As a result, parents may feel ashamed, isolated, or afraid of what others will say. Many also worry about their child’s future and how society will treat them."

In India, where family reputation and social expectations often matter, parents may worry about being blamed by relatives, neighbours or their child's school. This can lead to guilt and hesitation in seeking professional help.

“Children's mental health conditions come from a mix of genetics, brain development, stress and life events. Ordinary parenting choices do not cause them,” Dr. Madaan explains.

He speaks about the National Mental Health Survey, which reported a prevalence of about 7.3% among adolescents aged 13 to 17 across 12 states. A 2026 review of studies in India also identified stigma as a major barrier to adolescents seeking mental health care.

How Can Parents Protect Their Child From Stigma?

Also read: Attention Deficit May Be The Wrong Way To Understand ADHD, Says US Psychiatrist

Parents cannot control what others say, but they can decide how they respond and what their child hears at home.

Dr. Prasad advises parents to focus on their child's needs instead of worrying about how the family is perceived. Seeking professional help should be treated as a responsible step, not a source of shame.

He said, "Speak openly with your child, reassure them that their condition is not their fault, and never label or compare them with others. Set clear boundaries with people who make insensitive comments, and share personal information only with those you trust. Seek professional help when needed and maintain a supportive home environment."

The language used at home matters, too. If children repeatedly hear that they are a problem, a burden or a source of embarrassment, they may begin to believe it themselves.

Instead, parents should reassure them that they are loved and valued, and that their mental health difficulties do not define who they are.

Dr. Madaan recommends explaining the condition early and making it clear that the child is not at fault. This can help prevent internalised stigma, in which children begin to see their illness as a personal weakness. He said, "They may then be less likely to hide their symptoms or avoid seeking help."

Parents should also decide carefully who needs to know about the diagnosis. Dr. Madaan recommends informing the child's class teacher and family doctor early so they can provide appropriate support. He said, "Relatives who are told should respect the child's privacy and avoid discussing the diagnosis in front of the child or at social gatherings."

Recognising When A Child Needs Professional Help

Also read: Self-Diagnosis Could Go Wrong: Are We Overusing The Words Anxiety, Trauma and ADHD?

Stigma can delay treatment, making it important for parents to recognise changes in their child's behaviour and emotional well-being.

Dr. Madaan advises seeking an assessment when certain symptoms show.

He said, "Sadness lasting beyond two weeks, a sudden drop in school performance, withdrawal from friends, or changes in sleep and appetite call for a visit to a child psychiatrist."

A child psychiatrist may use screening tools like the Strengths and Difficulties Questionnaire for children or the PHQ-A for teenagers.

Parents should also follow the recommended treatment plan, attend therapy sessions and give prescribed medication as directed. They should consult the psychiatrist before stopping medication, even if the child appears to be doing better.

If The Child Is Being Bullied

For a child already dealing with mental health challenges, bullying can add another layer of psychological toll. Home should be a place where they feel heard, believed and protected.

“Parents should encourage open conversations and listen without immediately questioning, blaming, or dismissing the child’s experience,” says Dr. Prasad.

Responses such as “Why don’t you just ignore them?” or “You must have done something to provoke them” can leave children feeling that they have to manage the problem alone.

Instead, parents can say, “I am glad you told me. This is not your fault, and we will work through it together.”

If bullying occurs at school, parents should document incidents and speak to teachers or school authorities. Threats, physical harm and online harassment should be addressed promptly.

Parents can also encourage healthy friendships and activities that help children recognise their strengths. If bullying begins affecting their sleep, mood, school attendance or self-esteem, professional help could be necessary.

Parents Need Support Too

Also read: GLP-1 Drugs May Offer Mental Health Benefits, Reduce Schizophrenia Relapses: Lancet Study

Caring for a child with mental health challenges can leave parents exhausted. The pressure to manage treatment, family responsibilities and other people's opinions can take a toll on their own mental and emotional well-being.

Dr. Madaan said, "Caregiver burnout, a state of exhaustion that can bring low mood and anxiety, is common. Regular meals with fruit, vegetables and protein, seven hours of sleep and a daily walk keep energy steady. A parent support group or a counsellor offers a safe place to talk."

Talking to a counsellor, joining a parent-support group or confiding in family members can also provide a space to talk without fear of judgement. Experts say that parents do not need to manage every aspect of their child's care alone. Looking after their own well-being can help them remain better equipped to support their child.

For Dr. Prasad, tackling stigma begins with changing how families and communities talk about mental health.

“We should avoid labelling children as ‘abnormal,’ ‘weak,’ or ‘problematic.’ Instead, we should recognise that every child has different needs and may require different kinds of support,” he says.