Eight-month-old twins from Hayward Heath, West Sussex, recently met the surgeon who saved their lives even before they were born. The BBC reports how their mother, Katerina Ahouansou, at six months pregnant, during a routine scan, uncovered a serious issue with their development and blood supply.

Doctors diagnosed the twins with twin-to-twin transfusion syndrome or TTTS. It is a condition where one twin received more blood and nourishment than the other due to uneven blood vessel distribution in the placenta. In case there is no medical intervention, it could be fatal for both the twins.

A Specialist Steps In

This is when Ahouansou was referred to Professor Kypros Nicolaides at King’s College Hospital in London. Professor Nicolaides is a pioneer in fetal medicine and he specializes in a laser procedure that redistributes blood supply between twins in cases of TTTS.

When Ahouansou was scanned, Nicolaides observed that one of the twins were significantly smaller than the other. "There was a very high chance that if we did not intervene, both twins could die," he recalled.

An Operation No Less Than A Miracle

The life-saving laser surgery was performed and within a week the doctors saw an improvement with the twin who was smaller in size. When the twins were born, they weighed 1.5kg and 1.7kg. To recognize the efforts by the surgeon, Ahouansou named them Kai Kypros and Asher Nicolas after Professor Kypros Nicolaides.

Ahouansou also expressed deep gratitude for the professor's expertise and called him "proof that miracles can be performed by people who are devotees to their profession."

Professor Kypros Nicolaides has been at King’s College Hospital since 1980 and is widely regarded as a leader in fetal medicine. His groundbreaking research and development of screening and surgical techniques have saved countless lives.

Through his dedication, Professor Nicolaides has given many families hope, demonstrating how medical advancements continue to improve survival rates for complex fetal conditions like TTTS.

More about Twin-to-twin Transfusion Syndrome

As per the John Hopkins Medicine, TTTS is a rare pregnancy condition that affects identical twins or other multiples. It happens in pregnancies where twins share one placenta and a network of blood vessels that supply oxygen and nutrients essential for development in the womb. These pregnancies are known as monochorionic.

Sometimes, the blood vessels in the placenta are unevenly distributed, causing an imbalance in blood flow between the twins. The donor twin loses more blood than it receives, leading to malnutrition and potential organ failure. Meanwhile, the recipient twin gets an excess of blood, putting strain on the heart and increasing the risk of cardiac complications.

Impact on the Donor Twin

The donor twin loses blood volume (hypovolemia), reducing kidney function and urine production. This leads to low amniotic fluid levels (oligohydramnios) or, in severe cases, a complete absence (anhydramnios). Without proper blood circulation, the donor twin faces cardiovascular issues, increasing the risk of death.

Impact on the Recipient Twin

The recipient twin experiences excess blood volume (hypervolemia), causing increased urination and excessive amniotic fluid (polyhydramnios). The overworked heart struggles to handle the surplus blood, leading to cardiovascular dysfunction, heart failure, and, in extreme cases, death.

Musculoskeletal problems such as back pain, once more commonly associated with adulthood and old age, are increasingly being reported among schoolchildren, experts at the Indian Association of Physiotherapists (IAP) have warned.

Ahead of the World Physiotherapy Asia Western Pacific (WPAWP) Regional Conference 2026, IAP experts flagged a reported 40% rise in musculoskeletal problems among schoolchildren, citing sedentary lifestyles and poor movement habits as key concerns.

The experts called for greater focus on prevention, movement education and physical fitness from an early age.

“Back pain does not start in old age. We are seeing a concerning 40% rise in musculoskeletal problems among schoolchildren, and this should make us rethink how we approach preventive healthcare in schools,” Prof. Dr. Sanjiv K. Jha, President of the Indian Association of Physiotherapists (IAP), said.

He flagged concerns that long hours of studying and prolonged screen use are making children increasingly physically inactive. Reduced movement, along with inadequate strength, flexibility and fitness, may contribute to musculoskeletal problems and could have long-term consequences if not addressed.

“We need to shift from treating musculoskeletal problems after they appear to preventing them through early education, fitness and appropriate physiotherapy interventions,” Dr. Jha said.

Also Read: Gut Microbiome Linked To 3x Higher Type 1 Diabetes Risk In Children

Childhood Back Pain Is Already A Concern

Indian research indicates that musculoskeletal symptoms are a significant concern among school-going children.

A study of 934 children aged 8–15 years from four schools in Bhopal found that 55.9% reported pain during the previous 12 months, while 41.6% reported pain during the preceding 10 days and 21.3% had visited a doctor for the problem. The study also found that the average schoolbag weighed 16.5% of the students’ body weight.

Another study among schoolchildren aged 10–16 years in urban and rural areas of Khurda district, Odisha, found an 18.8% prevalence of musculoskeletal pain during the preceding year. The research examined factors including backpack weight, age, gender and body measurements.

Heavy Schoolbags Are Not The Whole Story

Read More: Are Children Breathing Clean Air Inside Classrooms? New European Study Raises Concern

Experts caution against attributing childhood back pain solely to heavy schoolbags. Scientific evidence suggests that musculoskeletal pain can have multiple contributing factors, including physical activity, movement habits, previous injuries, psychosocial factors, prolonged sitting and individual characteristics.

This points to the need for a broader approach to childhood musculoskeletal health rather than focusing exclusively on schoolbag weight.

“We should not totally link childhood back pain to a heavy-school-bag problem. Children need regular movement, physical fitness, strength, flexibility, good movement habits and awareness about how they use their bodies,” Dr. Ruchi Varshney, part of the IAP, said.

She added that physiotherapy can help schools introduce preventive programs focused on movement education, early identification of problems and healthy physical activity rather than waiting until pain becomes persistent.

Schools Can Play A Bigger Role

Physiotherapists believe schools can become important platforms for movement education, exercise, postural awareness, physical fitness, injury prevention, ergonomics, early screening and health promotion.

The larger message is that back pain should not be viewed as an inevitable problem of growing older.

Musculoskeletal health begins in childhood, and prevention should begin before pain becomes persistent.

Regular movement, physical fitness, strength and flexibility can help children develop healthy movement habits and support their musculoskeletal health as they grow.

Congenital heart disease (CHD) is not just a paediatric cardiac problem. It is a major public-health challenge. CHD is among the most common birth defects, affecting approximately 8–12 babies per 1,000 live births. In India, with a birth prevalence of around 9 per 1,000, this translates to approximately 2.4 lakh babies being born with CHD every year.

Indian consensus guidance has also estimated that CHDs may account for approximately 10% of infant mortality in the country. These numbers make one thing clear: we cannot treat congenital heart disease only after a child becomes sick. We need to find it earlier. And that is where newborn screening becomes a public-health priority.

The problem is not only CHD. It is missed CHD.

One of the biggest challenges is that a baby with a serious heart defect may look completely healthy at birth. Some critical congenital heart defects may have no obvious signs during the initial newborn examination. A baby may feed normally, have a normal colour and appear ready to go home—only to deteriorate days later when the circulation changes after birth.

By then, what could have been a planned referral can become an emergency. This is why “the baby looks fine” cannot be considered a heart check.

Also read: Elderly Diabetic With Rock-Hard Arteries Undergoes Advanced Calcium-Breaking Heart Procedure, Avoids High-Risk Surgery

Every newborn needs more than a visual assessment

A careful newborn examination remains essential, but it cannot identify every critical heart defect. This is where pulse oximetry can add another layer of protection. Pulse oximetry is a simple, non-invasive test that measures oxygen saturation. When performed alongside clinical examination, it can help identify babies with critical congenital heart disease who may otherwise be missed.

Importantly, pulse oximetry does not diagnose every form of CHD and a normal reading does not rule out all heart defects. It is a screening tool—not a substitute for clinical assessment or echocardiography. Indian studies have demonstrated the potential value of combining clinical examination with pulse oximetry. In one study of asymptomatic newborns, pulse oximetry alone detected 80% of critical CHD cases, clinical examination detected 60%, while combining the two identified all cases in that study.

This is where public health policy matters

The question should no longer be: “Can we screen some babies?” The question should be: “How do we ensure that no baby is missed simply because screening was not available?”

India has already demonstrated that population-level screening can work. Kerala's state-wide newborn programme incorporated pulse oximetry screening into government delivery centres. By 2019, more than 157,000 newborns had been screened, with the programme identifying 134 cases of CHD, including 74 critical cases.

This is the kind of approach that needs to move from individual hospital initiatives towards standardised newborn-care pathways across the country. At Cloudnine Hospitals, we have screened more than 3 lakh babies so far. Through this screening, we identified 92 cases of Critical Cyanotic Congenital Heart Disease (CCCHD). These findings highlight the value and cost-effectiveness of routine pulse oximetry screening in newborns.

Also read: Menopause & Heart Health: Why This Transition Can Be A Turning Point for A Woman’s Cardiovascular Future

Screening without referral is not enough

However, screening is only the first step.

A public-health programme must connect the entire chain:

Screen → Confirm → Refer → Treat → Follow up

A baby who screens positive needs timely access to echocardiography, paediatric cardiology, neonatal stabilisation and, when required, cardiac intervention. This is one of India's biggest challenges. Paediatric cardiac services, specialists, diagnostic facilities and transport systems are unevenly distributed, particularly between urban and rural areas.

Indian literature has highlighted the gap between the enormous number of babies who may require cardiac care and the country's capacity to provide timely specialised treatment. Therefore, universal screening without a strong referral and treatment network cannot solve the problem.

Early diagnosis changes the equation

The good news is that the story of CHD is no longer one of inevitable poor outcomes. With timely diagnosis and access to appropriate treatment, more than 90% of people born with CHD can survive into adulthood with good long-term outcomes. Treatment may include monitoring, medicines, catheter-based procedures, surgery or staged interventions, depending on the defect.

The challenge, therefore, is increasingly about closing the gap between what modern medicine can achieve and what a child actually receives. A child cannot benefit from a life-saving cardiac intervention if the heart defect is never detected, if the diagnosis is delayed, or if the family cannot reach the right centre in time.

Also read: Stopping Ozempic, Wegovy, Mounjaro Linked To 22% Higher Heart Attack, Stroke Risk: Study

The message to parents is simple

Parents should know that congenital heart disease is not always visible at birth. During pregnancy, recommended antenatal scans can help identify several structural heart abnormalities. After birth, a thorough newborn examination and, where available and appropriate, pulse oximetry screening can provide additional opportunities to detect critical heart disease.

Parents should also seek prompt medical attention if their baby develops:

• Difficulty or rapid breathing
• Bluish or greyish lips or skin
• Poor feeding or tiring during feeds
• Excessive sweating while feeding
• Poor weight gain
• Unusual lethargy or recurrent episodes of illness

These signs do not necessarily mean that a baby has CHD, but they should never be ignored.

From awareness to action

For too long, congenital heart disease has been viewed primarily as a specialist problem. It is time to view it as a newborn-health priority. If approximately 2.4 lakh Indian babies are born with CHD every year, then early identification cannot remain dependent on whether a particular hospital has a screening protocol or whether a family happens to reach a cardiac centre in time.

We need standardised newborn screening, trained healthcare professionals, reliable referral pathways, accessible paediatric cardiac services and long-term follow-up.

This is what public-health action looks like.

Don’t Miss a Beat

“Use Heart for Action” should mean more than awareness on World Heart Day. For newborns, it should translate into action at the point where it can make the greatest difference—before a silent heart defect becomes a life-threatening emergency. Each can be an opportunity to detect a problem earlier.

We cannot prevent every congenital heart defect. But we can work towards preventing a missed diagnosis from becoming a missed opportunity to save a child's life. Because every newborn deserves a heart check—and when it comes to a baby's heart, we cannot afford to miss a beat.

A child's lungs continue to develop well into adolescence, laying the foundation for respiratory health throughout life. When children grow up with smaller lung capacity, it means their lungs are unable to reach their full growth potential.

This can affect how efficiently the body takes in oxygen and may influence physical stamina, exercise tolerance and overall well-being. While the consequences are not always immediately visible, lung health in childhood can shape respiratory health decades later.

What Can Affect Lung Growth?

Lung development is influenced by several factors, beginning even before birth. Premature birth and low birth weight can affect early lung growth. During childhood, recurrent respiratory infections, poorly controlled asthma, exposure to tobacco smoke and prolonged exposure to air pollution may also influence lung function.

Nutrition, physical activity and genetic factors can contribute to differences in lung capacity between children.

How Can Smaller Lung Capacity Present?

Some children may have reduced lung function without obvious symptoms. Others may show signs during physical activity or respiratory infections.

Parents may notice:

• Breathlessness or unusual fatigue during play or exercise
• Difficulty keeping up with peers during physical activities
• Persistent cough or recurrent wheezing
• Frequent respiratory infections or prolonged recovery after illness

These symptoms can occur with several respiratory conditions, so they should not automatically be attributed to low fitness or smaller lungs.

Can Lung Function Be Improved?

Management depends on why lung function is reduced. When asthma or another airway condition is present, appropriate inhaled medicines can help control inflammation and improve breathing. Children with specific chronic respiratory conditions may benefit from supervised breathing exercises, respiratory physiotherapy or pulmonary rehabilitation.

Where poor nutrition or inadequate growth is a contributing factor, nutritional support may also be recommended. The focus is not simply on increasing lung capacity, but on treating the underlying condition and helping the child achieve the best possible lung function for their age and health.

What Can Parents Do?

Several everyday measures can support respiratory health while the lungs are developing. Regular age-appropriate physical activity, adequate nutrition and sufficient sleep are important.

Eliminating and reducing exposure to cigarette smoke, indoor pollutants and poor outdoor air quality can also help immensely. Recommended vaccinations and timely treatment of respiratory infections may further reduce the impact of preventable illness.

When Should Lung Function Be Evaluated?

Persistent respiratory symptoms, repeated chest infections, unexplained exercise intolerance, or a history of premature birth may warrant medical evaluation.

Depending on the child's age and symptoms, assessment may include a physical examination, oxygen measurement, lung function tests such as spirometry and Forced Oscillometry testing to identify the underlying cause and help determine whether medication, respiratory therapy, nutritional support, or other interventions are appropriate. In addition, sometimes undetected cardiac issues could be contributing and need attention and evaluation.

Protecting Lung Health Early

Childhood is an important period for establishing lifelong respiratory health. Minimizing exposure to harmful pollutants, encouraging physical activity and addressing respiratory problems early can help children reach their individual lung growth potential. The aim is not simply to measure how much air the lungs can hold, but to ensure they function as effectively as possible throughout childhood and into adulthood.

Food plays a very important role in this, as the saying goes, “we are what we eat”. Staying close to home-cooked, uncomplicated food is the key rather than app-based fast-food cravings.

(By Dr. Viny Kantroo, Senior Consultant, Pulmonary, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi)