Regional Sudden Unexpected Death in Infancy (SUDI) prevention update

News
06 Aug 2018

The Ministry of Health's National SUDI Prevention Programme (NSPP), aims to reduce the SUDI rate from 0.7 to 0.1 in every 1,000 births by 2025 with equity across all ethnicities.

The second iteration of the South Island SUDI Prevention Programme (SPP) regional plan and District Health Boards local SPP’s were submitted to the Ministry of Health (the Ministry) 20 July 2018.  The plans are living documents and are reviewed and updated annually. The South Island SUDI Prevention Coordinator Ann Shaw continues to work with the DHBs on actions to be undertaken to achieve equitable SUDI rates.

Key areas of focus continue to be access to smoking cessation during pregnancy/smoke free whānau after baby is born; provision of sleep spaces (wahakura or pepi pod) for babies identified as having SUDI risk factors, access to breast feeding support services, early engagement with a lead maternity carer (LMC), access to and engagement with pregnancy and parenting education, and workforce development. 

The Chief Coroner and SUDI

In a rare move, the Chief Coroner Judge Marshall spoke out on national television on 21 July 2018 saying ‘… SUDI has been steadily rising in New Zealand, despite major efforts to reduce it.’ Noting that the Coroners' figures are internal coronial data and may differ from other official data, Judge Marshall said the data show there were 51 cases of SUDI for 2017, (1 January to 31 December 2017) up from a low of 42 in 2012. She went on to say:

  • ‘… many of the deaths are preventable’
  • ‘… it's heartbreaking’’
  • ‘As coroners, we don't like to see these preventable deaths coming across our desks time after time, and we're talking about vulnerable babies', and
  • ‘The message is quite simple – every sleep should be a safe sleep.’

When watching the video, please bear in mind the safety aspects of car seats were not covered; that is there was no balancing discussion about safe use of car seats for their primary purpose; transport. Nor was there any reference to other modifiable risk factors such as smokefree.

Safe Sleep for P.E.P.E

P.E.P.E (Place, Eliminate, Position and Encourage) is the agreed national messaging for SUDI prevention. The P.E.P.E resources can be downloaded via this link.

Maternity Collection Data relevant to SUDI

The National Maternity Collection (MAT) data provides statistical, demographic and clinical information about selected publicly-funded maternity services before and after a birth (data is reported by calendar year). The New Zealand Maternity Clinical Indicators present comparative maternity interventions and outcomes data for pregnant women and their babies, by maternity facility and district health board region. As the 2017 South Island MAT data is not, 2016 MAT data is shown (from the South Island SPP Regional Plan).

Lead Maternity Carer Registration

Registration with an LMC in the first trimester is associated with improved outcomes for women and babies as it facilitates optimal screening, advice, support and referral. Increased first trimester LMC registration, with equitable rates for all ethnicities, is a Maternity Quality and Safety Programme (MQSP) and National Maternity Monitoring Group (NMMG) priority.  

The 2016 MAT data for the South Island show approximately 28 percent of Māori women (all ages), 40 percent of Pasifika women (all ages) and 35 percent of young women aged less than 20 years in 2016 did not register with an LMC in the first trimester of pregnancy.

Improving these rates is an important SUDI prevention action.

Smoking and SUDI

Smoking during pregnancy and postnatally is a key modifiable SUDI risk factor (greatest contributory percentage). Exposure to maternal smoking during pregnancy reduces the frequency of a baby’s arousal from sleep (important response to a life-threatening stimulus). Smoking in pregnancy is also a significant modifiable risk factor for preterm birth and intrauterine growth retardation (IUGR).

Overall 13.3 percent of women across the South Island in 2016 were documented as smoking on registering with an LMC, that is, registration at any stage of the pregnancy and 11.3 percent of women who birthed across the South Island were smoking at two weeks postnatal[1]. Reported smoking rates are most likely underestimated, as it is recognised that some women do not disclose they are smoking during pregnancy or postnatally.

[1]     Note: It is recognised that currently there is disconnect with reporting smoking postnatally; the maternity clinical indicators (Indicator 16) reports maternal smoking at two weeks postnatal and the Well Child Tamariki Ora (WCTO) Quality Improvement indicator reports a smokefree home at six weeks postnatal. It is being developed as a System Level Measure and is still in developmental stage (awaiting accuracy of data reporting and collection).

The impact of the smoking cessation incentives programmes for pregnant women in the South Island is still unknown. For the DHBs who introduced programmes during 2017, the 2017 MAT data, once available, may show a decrease in antenatal and postnatal smoking rates.

However, engaging Māori and young women aged less than 25 years in smoking cessation programmes is essential to reducing SUDI rates.

SUDI Prevention Programme National Coordination Service

Hāpai te Hauora, the SUDI prevention Programme national coordination service provider, produce a fortnightly SUDI e-newsletter that includes programme updates, recent research articles, upcoming events etc. You can subscribe to the newsletter by clicking on this link.