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

The gut microbiome may influence how type 1 diabetes develops in children at high genetic risk, a new study suggests.

Researchers found that children whose gut microbiome stopped developing early had about three times the risk of developing type 1 diabetes or the immune attack that precedes it, compared with those whose microbiomes continued to mature.

The findings, published in Nature Metabolism, also showed that genetics influenced how strongly some microbiome patterns were associated with disease risk.

Type 1 diabetes affects more than 9 million people worldwide, including 1.8 million children and adolescents.

"Understanding the role of microbiome development in diabetes progression could lead to early prediction and prevention strategies, giving us more options to delay or even prevent the clinical manifestation of this disease," said co-corresponding author Daniel Wang, associate scientist with the Channing Division of Network Medicine in the Mass General Brigham Department of Medicine.

Study Tracked Children From Early Life

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The longitudinal observational TEDDY Study followed 887 children at high genetic risk of type 1 diabetes and analyzed more than 12,000 stool samples collected during their first six years.

Participants came from Finland, Germany, Sweden and the United States.

Because the immune system can attack insulin-producing cells years before symptoms appear, researchers counted both the first detection of this immune attack and a clinical diagnosis as disease-related outcomes.

They identified three microbiome development patterns: early-matured, late-matured and early-plateaued.

Children with early-matured microbiomes developed greater bacterial diversity during their first year. Those with late-matured microbiomes started more slowly but eventually caught up.

The early-plateaued group showed slow development that failed to catch up, with low bacterial diversity persisting through the first three years.

Early Plateau Linked To Higher Risk

Children with an early-plateaued microbiome had about three times the risk of developing type 1 diabetes or its preceding immune attack.

The association was also seen when the researchers analyzed the immune stage and clinical diagnosis separately.

The finding emerged from repeated stool sampling over time, suggesting a single microbiome snapshot could have missed the association.

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Microbiome Reflected Dietary Changes

The bacterial differences also reflected how the children's microbiomes adapted as their diets changed.

In the early-matured group, bacteria shifted sooner from milk-adapted species such as Bifidobacterium toward bacteria that break down dietary fiber.

In the early-plateaued group, the microbiome remained more focused on digesting milk sugars even after solid foods were introduced and relied on a narrower range of bacterial species.

Genetics Also Played a Role

Lead author Danyue Dong, a postdoctoral research fellow in the Channing Division of Network Medicine at Mass General Brigham shared that "genetic background" can also influence the risk. Dong noted that combining microbiome and genetic information gives a more accurate picture.

"By analyzing interactions between the microbiome and host genetics, we found genetic variants, particularly those involved in antimicrobial and antiviral immune responses, that shaped how strongly the late-matured pattern was related to disease risk. The early-plateaued pattern, by contrast, carried higher risk regardless of genetic background," the expert said.

What It Means for Prevention

The study was observational, so it cannot establish that microbiome changes cause type 1 diabetes. Clinical trials are needed to determine whether modifying the microbiome can reduce disease risk.

The findings also came from children already at high genetic risk, meaning they may not apply to the general population.

Researchers say future pediatric care could potentially include microbiome testing during the first years of life. However, approaches such as dietary supplements would need to prove effective in clinical trials before being used for prevention.

A baby girl who reportedly appeared healthy after being born died at just 14 months after getting afflicted with a devastating, ultra-rare genetic neurological disorder that made her incapable of moving, feeding and interacting with the world around her.

Poppy Massey was born in February 2022 with no signs or symptoms of any illness. Her mother Kaylee Massey's told PEOPLE that they began having concerns when Poppy was around four months old and her vision did not appear to be developing normally.

Further testing disclosed abnormalities in the corpus callosum, followed by diagnoses including microcephaly and cerebral visual impairment.

She eventually got diagnosed with TBCD leukodystrophy, a rare inherited disorder affecting the brain and nervous system. Poppy died on April 30, 2023.

What Is TBCD Leukodystrophy?

TBCD disorder is a rare genetic condition that affects the brain and nervous system. It is caused by changes in both copies of a gene called TBCD, which is important for the normal development and functioning of nerve cells.

A child usually inherits one faulty copy of the gene from each parent. The parents typically do not have symptoms because they carry only one altered copy.

The condition can cause severe complications in brain development, movement, muscle strength and vision. Children may grow normally at first but then start showing symptoms like developmental delays, poor muscle, difficulties in feeding and moving, seizures, vision problems and loss of skills they had acquired previously.

TBCD-related neurodegenerative disease is sometimes grouped among leukodystrophies, a group of disorders that affect the brain's white matter.

White matter contains nerve fibres covered by a protective layer called myelin, which helps electrical signals travel efficiently through the brain and nervous system.

When this system is disrupted, communication between nerve cells can become impaired, contributing to the severe neurological symptoms seen in patients.

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Babies With TBCD Leukodystrophy May Initially Appear Healthy

One of the most difficult aspects of the disorder is that neurological problems may not be obvious immediately after birth. As the child's brain develops, symptoms can become more evident.

Brain imaging can show cerebral and cerebellar atrophy, a thin corpus callosum and impaired myelination. Some children subsequently experience stunted development.

In Poppy's case, her mother told PEOPLE that her condition deteriorated rapidly after diagnosis at nine months. She eventually lost the ability to suck and feed independently, lost movement in her legs and arms.

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TBCD Is An Exceptionally Rare & Severe Disorder

The nervous system depends on organised cellular structures to develop, transport materials and communicate between neurons. Disruption of the TBCD protein can interfere with these processes during early brain development.

The disease involves brain atrophy and impaired myelination, affecting movement, development, vision, swallowing and other neurological functions.

TBCD is exceptionally rare. The TBCD Foundation says fewer than 50 diagnosed cases are known worldwide, although the true number may be higher because rare genetic disorders may largely remain undiagnosed.

Some affected children have very severe symptoms right from the onset of the disease disease, while others may survive longer. It varies depending partly on the specific genetic variants involved. Currently, there is no proven cure or treatment for TBCD disorder.

Childhood weight gain is often noticed only when a child steps on a weighing scale. But the factors influencing a child’s weight can begin much earlier, hidden in everyday habits such as sleep, screen time, meals and physical activity. With busy family schedules and increasing screen use, healthy routines can sometimes take a back seat.

Supporting healthy habits from an early age is more useful than focusing only on a child’s weight or appearance. At the same time, regular growth monitoring helps pediatricians identify children who may need additional support. Not every child who looks chubby has obesity, and children’s body shapes naturally change as they grow.

Sleep and weight

Sleep is an important part of a child’s growth and development. Children who do not get enough sleep may experience changes in appetite, mood and energy levels. A tired child may also be less interested in physical activity and more likely to spend time sitting or snacking.

A consistent bedtime routine can therefore be an important part of maintaining healthy habits. Keeping screens away before bedtime, maintaining regular sleeping hours and creating a calm sleep environment can help children develop better sleep patterns.

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The screen-time connection

Screens have become part of children’s everyday lives, whether for schoolwork, entertainment or communication. However, excessive recreational screen time can reduce the time children spend running, playing and being physically active.

Screens can also encourage mindless eating. Children watching television or playing games may snack without paying attention to hunger or fullness. Sugary drinks, packaged snacks and frequent eating in front of screens can gradually become habits.

Parents can begin with simple changes, such as keeping meals and snacks screen-free and encouraging children to take regular breaks from sitting.

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Daily routines matter

Healthy weight management in childhood is not about strict dieting. It is about creating a balanced routine. Regular meals, nutritious snacks, adequate sleep and daily movement can help children develop healthy habits without making them feel that food or their body is a problem.

Children should be encouraged to eat a variety of foods, including vegetables, fruits, whole grains, pulses, dairy or suitable alternatives, eggs and other sources of protein. Simple, home-cooked family meals can form the foundation of a healthy diet. Highly processed foods and sugary drinks do not need to disappear completely, but they should not become everyday staples.

Physical activity should also feel like play rather than punishment. Cycling, dancing, outdoor games, swimming, walking or simply playing with friends can help children stay active while having fun.

Parents do not need to change everything overnight. Small, consistent steps can make a difference. Set predictable meal and sleep timings, create screen-free family meals, encourage outdoor play and avoid using food as a reward or punishment.

Most importantly, avoid making children feel ashamed about their weight. Focus on health, strength, energy and healthy habits rather than appearance.

Better sleep, healthy screen habits, nutritious food and regular movement can help children build a healthier relationship with their bodies and food. When parents create healthy routines for the whole family, children are more likely to adopt them naturally and carry those habits into adulthood.