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

While infertility has long been viewed as a women’s issue, experts stress that men account for nearly half of all cases. According to fertility specialists, male infertility contributes to around 40% of infertility cases, with female factors responsible for another 40%, and combined or unexplained causes making up the rest. Alarming trends show a steady rise in male infertility, largely due to low sperm count, lifestyle factors, and sexual health issues.

Dr. Avantika Vaze Parab, Fertility Specialist at Nova IVF Fertility, Vashi, Mumbai, explains that several reproductive health conditions in men can impact their ability to father a child, many of which are treatable if identified early.

Common Medical Conditions That Affect Male Fertility

One of the most common causes of male infertility is varicocele, a swelling of the veins in the scrotum that increases testicular temperature and hampers sperm production. “It often goes unnoticed but can be treated through medication or, in some cases, surgery,” says Dr. Parab.

Hormonal imbalances also play a significant role in fertility. Hormones such as FSH, LH, and prolactin, released from the pituitary gland, along with testosterone produced in the testes, are essential for healthy sperm production. Any disruption in these hormones can reduce sperm quality and quantity.

Infections of the reproductive tract, including untreated sexually transmitted infections (STIs) or illnesses like mumps during childhood, may cause long-term damage to sperm-producing tissues, leading to infertility.

When Sperm Can’t Reach the Ejaculate

In some men, sperm production occurs normally, but blockages in the reproductive tract prevent sperm from being ejaculated. “In such cases, sperm can still be retrieved directly from the testes through procedures like TESE (Testicular Sperm Extraction) or PESA (Percutaneous Epididymal Sperm Aspiration),” explains Dr. Parab. These sperm can then be used in advanced fertility treatments such as ICSI (Intracytoplasmic Sperm Injection), allowing men to father children with their own sperm despite the obstruction.

The Impact of Sexual and Lifestyle Factors

Sexual dysfunctions such as erectile dysfunction or premature ejaculation are another major contributor to male infertility. These issues are often linked to stress, obesity, or chronic conditions like diabetes, and they can strain both fertility and relationships.

Lifestyle habits also play a major role. Dr. Parab emphasizes that smoking, excessive alcohol consumption, obesity, lack of physical activity, and exposure to chemicals or radiation can all impair sperm health. “Even when sperm are produced, their count or motility may be too low for natural conception,” she notes. In such cases, assisted reproductive treatments like IUI (Intrauterine Insemination) or IVF/ICSI may be recommended.

Genetic and Hormonal Conditions

Certain genetic disorders, such as Klinefelter’s syndrome or Y-chromosome microdeletions, can lead to very low sperm counts or even azoospermia (zero sperm count). These require specialized diagnosis and fertility support.

Breaking the Stigma Around Male Infertility

Dr. Parab underscores that infertility is a shared responsibility, not solely a woman’s issue. “For generations, men have been hesitant to seek medical help due to social stigma,” she says. A basic semen analysis is often the first step for men who are trying to conceive.

Adopting a healthy lifestyle, quitting tobacco and alcohol, eating a balanced diet, exercising regularly, and consulting a doctor early can significantly improve fertility outcomes. “Seeking timely medical guidance helps men take the right steps at the right time,” Dr. Parab concludes.

Staying hydrated during pregnancy is crucial, but not every beverage that quenches thirst is safe for a mom-to-be. From morning coffee to bedtime teas, the choices can get confusing. So, how do you know which drinks are actually good for you and your baby?

We spoke to Dr. Sushruta Mokadam, consultant obstetrician at Motherhood Hospital, Kharadi, Pune, who rated the most common beverages consumed during pregnancy — from best to worst — and explained what makes them safe or risky.

Water

She recommends drinking at least three litres of water daily. “If plain water feels boring, try adding slices of lemon, cucumber, or mint. Detox water can be a refreshing and healthy alternative,” she adds.

Milk

Milk is packed with calcium, protein, vitamin D, and iodine, all vital for the baby’s bone, tooth, and brain development. “Milk is one of the most wholesome drinks for expectant mothers, provided it’s pasteurized,” says Dr. Mokadam.

She advises choosing between low-fat or full-fat milk based on your dietary needs. For those who are lactose intolerant or prefer plant-based options, fortified almond or soy milk can be good substitutes — as long as they’re enriched with calcium and vitamin D.

Fresh Fruit Juices

Freshly squeezed juices provide a good dose of vitamins, minerals, and antioxidants. “Juices like orange, pomegranate, or apple can help boost your well-being,” explains Dr. Mokadam.

However, she cautions against overconsumption: “Juice lacks fiber and is high in natural sugars. One small glass a day is fine, but going overboard can lead to unnecessary calorie intake and affect blood sugar levels.”

Herbal Teas

Many pregnant women turn to herbal teas for relaxation or to ease nausea. “Mild herbal teas like ginger or chamomile in moderation can help with digestion or morning sickness,” says Dr. Mokadam.

But not all herbs are safe. “Avoid teas with licorice root, pennyroyal, or unknown herbal blends. Always check with your doctor before adding any herbal tea to your routine,” she advises.

Coffee and Black/Green Tea

Caffeine crosses the placenta and can affect the baby’s heart rate. “It’s best to limit caffeine to less than 200 mg per day,” warns Dr. Mokadam. That’s roughly one small cup of coffee or two cups of tea. Too much caffeine may increase the risk of miscarriage or low birth weight.

Soft Drinks, Energy Drinks, and Sugary Beverages

These are high in sugar, artificial additives, and caffeine, with no nutritional value. “They can increase the risk of gestational diabetes, excessive weight gain, or even affect fetal growth,” says Dr. Mokadam.

She advises cutting them out completely for better overall well-being.

Pregnancy is a time when woman need to be extra careful with what they consume. There are always endless recommendations, and thus sometimes it could be difficult to separate fact from fiction, especially when it comes to protein intake. While protein is essential for everyone, however, during pregnancy, it plays a critical role in maternal health and fetal development.

Why Does It Matter?

A recent study has shown that lead has been found in popular protein powder, and the highest found in whey protein powder, or the plant-based protein powders. This is concerning, as protein are essential during pregnant as they contribute directly to the growth and development of the baby.

Proteins are made up of amino acids- body's building blocks. These amino acids help build and repair muscle and create hormones and produce enzymes.

A study published in Advances in Nutrition highlights that pregnancy is an “exceptional stage of life defined by rapid growth and development.” From just weeks after conception, the body adjusts protein metabolism to support fetal growth. Most protein deposits occur in the third trimester, reinforcing the importance of consistent protein intake throughout pregnancy.

Read: High Levels Of Lead Found In Protein Powders And Shakes, Reveals Consumer Reports

How Much Protein Do You Need?

Recommended protein intake usually varies by country, for instance in Australia, the RDI for pregnant women s around 60 grams per day, whereas 46 grams for non-pregnant women.

Are Protein Powder Safe During Pregnancy?

Yes, they are safe, unless they contain lead and other contaminants, which must be checked by the list published by the Consumer Reports and your local physician, gynaecologist and nutritionist.

There are several plant-based proteins that have the highest lead content in them, they are:

• Whey protein: Derived from milk; contains all essential amino acids. Not ideal for lactose-intolerant individuals.
• Hemp protein: Plant-based, safe for vegetarians and vegans.
• Pea protein: Plant-based, rich in branched-chain amino acids (BCAAs).
• Rice protein: Vegan-friendly, made from brown rice.

What Is An Alternative?

The RDI could be achieved with a manageable and balanced diet that includes:

Complete proteins: Lean meats, fish, eggs, dairy

Combined plant proteins: Legumes with grains or nuts (e.g., peanut butter on whole-grain toast)

A diet rich in fruits, vegetables, whole grains, legumes, nuts, and moderate protein sources, whether plant-based or animal, supports both maternal and fetal health. Weight gain is expected during pregnancy, and incorporating protein helps ensure that gain is nutrient-dense. For individual guidance, consulting a GP or dietitian is recommended.

Other alternatives like protein bars, or homemade bars, which use dates, nut butter, and seeds could be a healthier option as they do not contain added sugar.