"Suffice to say that risk factors for SUDI [Sudden Death in Infancy] include poverty, smoking, ethnicity, low socioeconomic status, rates of drug and alcohol utilisation, poor housing, rates of breast feeding, rates of immunisation, and similar factors, which are not stacked favourably for many of the babies born in Whanganui."
Dr Montgomery said he had personally reviewed every SUDI death in Whanganui in the last several years.
"What I can say with certainty is that education about SUDI prevention is being provided, as are resources such as smoking cessation, breastfeeding support, safe sleeping solutions, drug and alcohol counselling, and social work support. Many mothers are accepting the advice and support which is on offer. However, some babies are still dying in unsafe sleeping environments, despite all these efforts."
The reasons were still "poorly understood" Dr Montgomery said.
"I hope that the recent publicity around Safe Sleeping Spaces, and the government's recent commitment to supporting this, will help to make a difference in convincing all parents to ensure that babies always sleep in a safe place. This alone would drastically reduce the rates of SUDI."
Health Minister Jonathan Coleman recently announced a national rollout of pepi-pods or wahakura, special bassinets that allow a baby to safely sleep in the same bed as their parents.
Whanganui District Health Board announced in early 2014 they would be funding pepi-pods after a review showed the districts rate of infant deaths to be 4.03 for every 1000 live births in the four years to 2012.
Since then, the rate has dropped to 3.65 in 2009-2013, and 3.29 in 2010-2014.
A safe sleeping environment is:
- Free from other people who might overlay the infant. Sleeping arrangements must ensure that if someone else moved while sleeping, the infant would still be able to breathe easily with a clear airway.
- Free of gaps that could trap or wedge. There should be no gaps that might trap an infant, wedge them and make breathing hard or impossible.
- Firm so the neck did not flex and compromise the airway, and the face couldn't get buried in the surface if the infant rolled into the prone position.
- Flat so the infant did not suffer compromise to the airway or breathing by rolling over, tipping out, inversion of sleep space or becoming wedged.
- Free from objects that might cover the face or cause strangulation or neck flexing. This could include pillows, bedding, sleep restraint apparatus or low-hanging mobiles.
- Free to breathe so the infant had no restriction of chest movement from pressure on the chest, tight wrapping or heavy bedding.
- Free from tobacco smoke. Babies should sleep in smoke-free environments.
In addition, infants should be:
- Placed on their back to sleep.
- In the parents' room for the first six months.
- At a comfortable temperature, avoiding overheating.