Despite the tangle of emotions it would inevitably bring, the couple made the decision to try for another baby almost straight away, because of Katherine's age and because they didn't want there to be too much of an age gap between their next child and their surviving daughter, Jorja.
"We always wanted two children," says Katherine. "The decision was not to replace Ruby ... our family was not complete anymore and we didn't want Jorja being on her own.
"It was just a relief it had happened. We found out what sex we were having. That helped, knowing we were having another girl."
Within two months of Ruby's death, not only was Katherine pregnant, but she was also back working part-time as a paediatric nurse at Tauranga Hospital.
"I had a really busy night shift so that helped. They babysat me for a couple of weeks," she recalls.
"Not many people go back to work at the place where their daughter died. Every time I go to work I re-live it. I should drive in the back way, but I don't, I drive in the front way."
Although Katherine laughs that she "doesn't do pregnancy well", she had a healthy pregnancy and on March 18 gave birth to an equally healthy baby girl.
It was not until six weeks later, on the anniversary of Ruby's death, that she finally fell apart.
"When Ruby died I held it together but when it came to the anniversary I plunged into a little bit of darkness," says Katherine.
"The hard thing for me was putting Sienna into Ruby's room and moving Ruby's photos out ... and watching other children her age grow up. You wonder what Ruby would be like. It stings a little bit."
But, while Ruby is no longer physically with them, the Smarts' home and garden is bursting with memories of her.
Her face beams from photos in every room and a special garden has been designed in her honour.
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"The concept was to have a place to sit in, that would be Ruby's area. We created it around the playhouse. You can see it from Sienna's room and the lounge. I often sit and stare out the window and go off into a little trance. Gardening in this area makes me feel like I'm spending time with Ruby."
Katherine has also commissioned a painting, to be completed by her 40th birthday in December, depicting all three girls.
In the picture Jorja, Sienna and Ruby's treasured "Bunny" will be peering into a book and the pictures in the book will be of Ruby. It will also incorporate butterflies and a rainbow - two symbols that remind them of her.
"I've had three babies and it's hard to work out where that all fits in. We have photos of Jorja and Ruby together and photos of Jorja and Sienna together but Ruby and Sienna will never be together. Ruby was so important in our lives and I want her to be there visually."
Ruby's favourite clothes have also been made into a quilt, which is draped across the foot of Katherine and Dion's bed. A work of art in itself, Katherine worked on it every Wednesday morning, when she would have been with Ruby at speech language therapy.
"Sometimes I get a bit of burn-out and feel like running away and hiding," admits Katherine.
"I don't get that down time. My Nana taught me to crochet. I try to crochet in the evenings. It stops my head thinking. Dion takes his iPod to bed so his mind doesn't go over it all the time. The vision of her passing is still there."
The wound still raw, her mind does not wander, but jolts sharply back to that night and the preceding days, as it so often does.
That Easter, Ruby had had a 24-hour vomiting bug, but appeared to have recovered.
On the Monday Katherine went up to Auckland to help a friend who was in hospital with a premature baby.
She thought Ruby might be teething as she was a little out of sorts and instructed Dion to give her paracetamol. When she developed a high temperature he took her to the doctor, as she was prone to ear infections. Finding nothing, the doctor sent her home, saying it was just a virus.
However by Wednesday Ruby was vomiting again so Dion rang Katherine and asked her to come home.
"She was awake when I got home and we had a big cuddle. She wasn't irritable and she was drinking," says Katherine.
The next morning she ate an ice-block and drank a bottle of milk and that evening, having "perked up", she went to bed at the usual time.
Later that night when she woke she joined her dad on the sofa where he was eating an icecream. He handed it to her to finish and put on a Hi-5 DVD.
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"She felt hot," says Katherine.
"I thought her temperature was lasting too long and I would definitely take her to the doctor in the morning."
Ruby fell asleep on her mum then suddenly woke a short time later and leapt out of her arms.
"She looked straight through me. We couldn't rouse her. I said to Dion 'she looks funny to me, ring an ambulance'. It felt like forever before the ambulance came."
In the ambulance Ruby drifted in and out of consciousness, until they arrived at Tauranga Hospital's emergency department.
"They tried to revive her but she had completely shut down. She let out a horrible cry and called out 'Mummy', 'Naddy' (she couldn't say Daddy), and 'Unny', for her toy rabbit 'Bunny', and took her last breath.
"We arrived at the hospital at 9.45pm and she died at 10.50pm. They tried for ages to resuscitate her. It just got to the point, because I knew some of the staff, where I asked them to stop. It was just so surreal.
"The ED staff cleared a room for me and Ruby and I lay down on the bed, just cuddling her and having that alone time with her."
At 5am she went home, tasked with having to tell Jorja, who was then 4, that she no longer had a sister.
"It was quite strange because Jorja would get up every morning and go into Ruby's room. That Friday morning she didn't. She slept in and went straight to the lounge and watched TV. We waited for her to come into our room. She hadn't even asked where Ruby was.
"We had put the cat down in December and we said we had taken Ruby to hospital in the night and she was too sick to come home and she was in heaven with Cuddles. Jorja just accepted that. She didn't really understand."
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Although part of her tortures herself that if she hadn't been away that week she would have acted sooner, in reality Katherine knows she probably wouldn't have - because Ruby showed none of the warning signs of meningitis until it was too late.
"She had no irritability. She was grizzly because she was hot but she wasn't holding her head like she had a headache and she wasn't photophobic.
"We were such frequent flyers to the hospital ... the times I took Ruby to the hospital it always turned out to be a virus, so I thought I would tough it out and take her to the doctor in the morning."
The recent meningitis outbreak in Northland has her urging parents to take their children to the doctor any time of the day or night if they are concerned.
"Sienna has already been to the doctor a couple of times. Your confidence as a parent and as a nurse as well drops off. If I couldn't save my own baby what's my judgement like?" she questions herself.
"I certainly know after Ruby passed away whenever friends' kids were unwell they took them to the doctor straight away."
Born with a soft cleft palate, which meant the back of the roof of her mouth was missing, Ruby had endured two painful surgeries in her short life.
Katherine painstakingly expressed milk for the first three months after Ruby was born, and bottle fed her with a special teat.
"It would take two hours to feed. She used up all her calories feeding, would have a five-minute sleep and it was time to get going again," recalls Katherine.
Ruby's hearing was also affected and it was not until she was 6 months old that, when she was fitted with hearing aides, that she was able to hear for the first time.
"Despite all that Ruby never gave off that she was a hard-done-by child. She took it in her stride."
Katherine believes Ruby, who was tiny for her age, had a lowered immunity as a result of being a poor eater.
"She would often pick up viruses, tummy bugs. I put it down to poor eating. It was not a medical thing. I felt she was a bit run down. She drank milk and she did eat food, but not enough. She was only a kilo heavier at 20 months than what she was at 10 months."
But what she lacked in size she made up for in personality.
"Ruby was a bouncy, bubbly, very mischievous little girl. She was quite bossy. She had Jorja wrapped round her little finger," says Katherine.
"She loved music. And her soft toy rabbit - he went everywhere with her. She was full of life and she bounced everywhere. She was a cheeky little monkey."
Sienna, by comparison, is placid, yet determined.
"She's very smiley and happy."
Although she sleeps in what was Ruby's room and her middle name, Rose, alludes to the birth flower of the sister she will never meet, Sienna is very much her own person.
"You've got to wonder what the greater plan in life is. Your children are special, but there was something about Ruby that she was meant to be here and obviously her role was to be here for just a short time, not a long time. I liken her to a butterfly that flits in and out. They are beautiful enough to make us stop and look and see their beauty and then they are gone," says Katherine.
"We are so lucky to have another baby and for it to happen straight away. Sienna was meant to come along. She has certainly brought a lot of joy."