New Zealand crib death prevention ‘stalled’ by long wait for investigations

Faced with the worst sudden death rate in the developed world, the New Zealand government set a national reduction target in 2017 and stepped up measures to prevent deaths. Three years later, is the Government on the right track? Nobody really knows.

Healthcare workers trying to reduce the number of crib deaths in New Zealand are “flying blind” due to a huge backlog of investigations.

The delay in obtaining reports from medical examiners on infant deaths, often three years or more, means that experts cannot say whether the interventions are working.

That’s a concern for the sector because the most recent data available on Sudden Unexplained Death in Childhood (SUDI) showed that rates were stagnating after several years of declines. Among the Pacific population, the rates were increasing.

“At the simplest level, we run in the dark,” said Professor Ed Mitchell, an infant death researcher at the University of Auckland and a member of an advisory group of experts at SUDI.

Mitchell said there was always a delay with SUDI cases due to the complexity of the investigations, but that he did not recall a time when they were so far behind.

“Indeed, we are two and a half years behind what is really happening. So it is really difficult to know if [initiatives] are they working or not. “

New Zealand has one of the highest SUDI rates in the developed world. More than half of babies are accidentally suffocated by parents while sleeping in the same bed.

Maori and Pacific babies are more likely to die due to high rates of smoking during pregnancy (which can create breathing difficulties for your children) and cultural customs of bed sharing.

In 2017, the national government launched a national prevention campaign and set a goal of reducing the SUDI rate from 0.7% per 1000 live births to 0.1% by 2025.

In 2017, the most recent statistics available, there were 48 deaths from SUDI, or 0.8 deaths per 1,000 births. Of that total, 26 babies were Maori and 12 Pasifika babies.

Mitchell said the government’s goal of reducing deaths to just six a year will always be ambitious.

“To do this, every pregnant mother would have to quit smoking. You and I both know that won’t happen for five years.”

But without up-to-date data it was difficult to know whether health messages and resources were reaching the families who needed them and, if so, why they were not being adopted.

Data from the Ministry of Justice show that the average time to close a coronary case is currently 479 days. Investigations into infant deaths may take longer because underlying conditions and other potential causes must be ruled out before they can be confirmed as SUDI.

Chief Coroner Deborah Marshall said the main driver behind the large number of backlogs was the increased number of cases in 2018/19 – 200 more than the previous year.

The Attorney General appointed eight additional relief medical examiners earlier this year, and they have been hired in recent months. But at the same time, six longtime forensic doctors had resigned or retired, five of whom had been replaced.

By law, there is a limit of 20 coroners. Once the vacant positions are filled, there will be 18 full-time medical examiners and eight relief medical examiners.

“As the newly appointed respite medical examiners and full-time medical examiners adjust to their roles, I hope the backlog will be reduced and long wait times will improve,” Marshall said.

Selah Hart, Executive Director of SUDI Hāpai Te Hauora’s National Prevention Service, said the Health Ministry provided interim monthly data on SUDI deaths every month, but was not robust enough to base prevention measures .

He didn’t want to say what those data showed, but hinted that SUDI rates weren’t falling: “We have a lot more to do, especially for our Maori babies.”

The national prevention program established in 2017 funds DHBs to educate families and provide them with safe sleeping devices. About $ 5 million is spent on education, and 8,500 capsules of pepi, wahakura and cots are provided annually to at-risk families.

Hart said the delays in getting strong results were “stalling” Hāpai Te Hauora’s ability to “kick out key jobs” in areas with high SUDI rates. His team has met with the chief coroner to discuss the problem.

“It’s no one’s fault,” Hart said. “It’s just that there is no capacity to meet the demand to investigate every SUDI death in a timely manner that is not three years behind us.”

The most recent SUDI cases highlight that providing health counseling to families is not always enough.

In a report published in June, a coroner said that an Auckland family had spoken with health professionals about sharing a bed with their two-month-old son and had been carefully following the advice. He was a healthy and educated child.

But one night in January 2017, the mother was overwhelmed with exhaustion while nursing her son in her bed and fell asleep. He died that night.

“His death in such sad circumstances highlights the vigilance that must be maintained to ensure that every dream of a baby is a safe dream,” said the coroner.