What is SUDI?

Each year in Aotearoa, around 50 pēpi die from Sudden Unexpected Death in Infancy (SUDI) – and most of these deaths can be prevented. Māori babies are the most affected, followed by Pacific babies, with rates much higher than for non-Māori.

SUDI is when a baby under one year dies suddenly and unexpectedly during sleep, often without warning. Sometimes a cause is found after investigation, but sometimes there isn’t one. For whānau, it is one of the most heartbreaking losses imaginable.

What increases risk for SUDI

• Smoking in pregnancy
• Bedsharing with pēpi if māmā smoked in pregnancy
• Unsafe sleep spaces
• Alcohol or drug use around pēpi
• Premature pēpi (born early) or very small (under 2500 g)

Research shows:

• Smoking in pregnancy = 6x increased risk of SUDI
• Smoking in pregnancy + bedsharing = 32x increased risk of SUDI

What the research tells us?

Since the 1980s, SUDI deaths in Aotearoa have dropped from around 250 per year to about 50 per year. This reduction is linked to safer sleep messaging (eg: pēpi on their back, smokefree pregnancy).

But preventable deaths still occur – especially when smoking in pregnancy and unsafe bedsharing combine. Whānau-centred and culturally grounded approaches are key to further reducing SUDI.

Our aim is to make safe sleep knowledge easy to understand and apply at home, so every pēpi has the strongest foundation for life.

Common terms

SUDI – An umbrella term for unexpected infant deaths in the first year. It includes both explained and unexplained cases.

SIDS – Sudden Infant Death Syndrome. An unexplained infant death after full investigation including autopsy and scene review.

Bedsharing – When pēpi shares a sleep surface with another person (intentionally or unintentionally).

Safe sleep environment – Pēpi sleeps on their own firm, flat surface with firm sides, made for babies (wahakura, pēpi-pod, bassinet, cot). Not couches, chairs, pillows, or folded duvets.

References

• Mitchell EA, Thompson J, Zuccollo J, MacFarlane M, Taylor B, Elder D, Stewart A, Percival T, Baker N, McDonald G, Lawton B, Schlaud M, Fleming P. The combination of bedsharing and maternal smoking leads to a greatly increased risk of sudden unexpected death in infancy: The NZ SUDI Nationwide Case Control Study. NZ Med J. 2017.
• Mitchell EA, Scragg R, Stewart AW, Becroft DMO, Taylor BJ, Ford RPK, Hassall IB, Barry DMJ, Allen EM, Roberts AP. Results from the first year of the New Zealand Cot Death Study. NZ Med J. 1991; 104: 71–76.
• Tipene-Leach D, Abel S. The wahakura and the safe sleeping environment. J Prim Health Care. 2010; 2(1): 81–88.

Sudden Death in Infacny (SUDI)

Each year in Aotearoa, around 50 pēpi die from Sudden Unexpected Death of an Infant (SUDI) and most of these deaths can be prevented. Māori babies are the most affected, followed by Pacific babies, with rates much higher than for non-Māori.

SUDI is when a baby under one year dies suddenly and unexpectedly during sleep, often without warning. Sometimes a clear cause is found after investigation, but sometimes there isn’t one. For whānau, it is one of the most heartbreaking losses imaginable.

What increases risk for SUDI

Māmā smoked during pregnancy
Bedsharing with pēpi if māmā smoked in pregnancy
Unsafe sleep spaces
Alcohol or drug use around pēpi
Premature pēpi (born early) or very small (under 2500 grams at birth)
Research shows:

• Smoking in pregnancy = 6x increased risk of SUDI
• Smoking in pregnancy + bedsharing = 32x increased risk of SUDI

This website provides clear information, practical guidance, and resources to help whānau keep pēpi safe while they sleep. Our aim is to make safe sleep knowledge easy to understand and apply at home, so every pēpi has the strongest foundation for life.

Sudden unexpected death in infancy (SUDI) is a leading cause of preventable death in New Zealand babies. Since the 1980s, the number of SUDI deaths reduced from 250 per year (over 4.4 per 1,000 live births) to 44 deaths in 2015 (0.71 per 1000 live births). Significant reduction in the rate of SUDI has occurred over the past three plus decades, but too many of our babies are still dying. It is estimated that up to 37 of the 44 deaths in 2015 could have been prevented (Mitchell et al 2017).

In the 1980s, New Zealand had one of the highest Sudden Infant Death Syndrome (SIDS) rates (over 4.4 per 1,000 live births) in the Western world. The New Zealand Cot Death Study (1987-1990) identified three key risk factors: prone (front) sleep position, maternal smoking and lack of breastfeeding (Mitchell, Scragg et al. 1991). A year later, bed sharing was also identified as a risk factor (Mitchell, Taylor et al. 1993) and later this was found to be particularly so where mothers smoked in pregnancy, (Carpenter, Irgens et al. 2004) became excessively tired or used alcohol (Blair, Fleming et al. 1999) or had used sedative drugs (Kahn and Blum 1982).

In the late 1990s the SIDS prevention advice was updated on the basis of research findings, and recommend that babies sleep on their backs only and not on their sides or fronts. Researchers considered that uptake of the new advice contributed to the gradual decline in SIDS rates up until 2000 (Mitchell et al 2007). These SUDI prevention public health messages, first promoted in the 1990s, remain applicable today (Mitchell et al 2017). A safe sleep and smokefree environment is vital for every baby and this message should be reinforced and supported through a mix of universal and tailored SUDI prevention services.

More recently, the combination of bed sharing and maternal smoking in pregnancy has been established as extremely hazardous to babies, leading to a 32-fold increased risk of SUDI, compared with babies not exposed to either risk factor (Mitchell et al 2017). It can be very difficult for pregnant women and mothers to quit smoking, especially if their friends and other members of their household are smokers. As such, tailored, supportive and appropriate smoking cessation services are required. Similarly, widespread availability of safe sleep devices will help support a safe sleep environment for baby, wherever they may be.

New Zealand has a particular challenge in that, the greater proportion of deaths are in the Māori community and are known to be drawn from those infants who bed-share with another person (Hutchison, Rea et al. 2011) and where the mother smoked in pregnancy, a behaviour known to be high in the Māori community (Tipene-Leach, Hutchison et al. 2010). The Pasifika community also has a high rate is recently found to be not decreasing over time, innovative approaches to addressing the inequitable SUDI rates is needed.

Commonly Used Terms

Bed sharing is when two or more individuals (infant and another individual including other children) share a surface, such as a bed, or other surface when they are asleep (either intentionally or unintentionally).

Safe sleep environment/surface/device is when a baby is placed on their own sleeping surface. The most common form of safe sleep environment is a bassinet, or cot, however more recently this has also included a wahakura (flax woven baby bed), BabyStart Box and the Pepi-pod these are designed to be put on the parental bed or another firm surface before placing the baby in them for sleep.

Sudden infant death syndrome (SIDS) is the sudden death of an infant (under one year of age) that cannot be explained after a thorough examination is conducted, including an autopsy, examination of the death scene and review of the clinical history.

Sudden unexpected death in infancy (SUDI) is an umbrella term that describes the death of an infant that was not anticipated, within the first year of life. Deaths categorised as SUDI contains a spectrum of cases from those that are unexplained following full investigation (SIDS, as above) to fully explained cases (explained SUDI). Between them are cases where a pathologist or coroner cannot be certain as to whether the death is explained or not; these are often labelled ‘unascertained’. Previously these deaths were known as ‘cot deaths’ and then people began to use the term SIDS. Now the preferred term is SUDI, although this umbrella term includes the group of unexplained SIDS deaths, as noted above.