title: Safe sleep practices in a New Zealand community and development of a Sudden Unexpected Death in Infancy (SUDI) risk assessment instrument.
abstract: BACKGROUND
  Interventions to prevent sudden unexpected death in infancy (SUDI) have generally been population wide interventions instituted after case-control studies identified specific childcare practices associated with sudden death. While successful overall, in New Zealand (NZ), the rates are still relatively high by international comparison. This study aims to describe childcare practices related to SUDI prevention messages in a New Zealand community, and to develop and explore the utility of a risk assessment instrument based on international guidelines and evidence.
  
  
  METHODS
  Prospective longitudinal study of 209 infants recruited antenatally. Participant characteristics and infant care data were collected by questionnaire at: baseline (third trimester), and monthly from infant age 3 weeks through 23 weeks. Published meta-analyses data were used to estimate individual risk ratios for 6 important SUDI risk factors which, when combined, yielded a "SUDI risk score".
  
  
  RESULTS
  Most infants were at low risk for SUDI with 72% at the lowest or slightly elevated risk (combined risk ratio ≤1.5). There was a high prevalence of the safe practices: supine sleeping (86-89% over 3-19 weeks), mother not smoking (90-92% over 3-19 weeks), and not bed sharing at a young age (87% at 3 weeks). Five independent predictors of a high SUDI risk score were: higher parity (P =0.028), younger age (P =0.030), not working or caring for other children antenatally (P =0.031), higher depression scores antenatally (P =0.036), and lower education (P =0.042).
  
  
  CONCLUSIONS
  Groups within the community identified as priorities for education about safe sleep practices beyond standard care are mothers who are young, have high parity, low educational levels, and have symptoms of depression antenatally. These findings emphasize the importance of addressing maternal depression as a modifiable risk factor in pregnancy.
authors.affiliation: Department of Women's & Children's Health, University of Otago, Dunedin, New Zealand. barbara.galland@otago.ac.nz.
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Galland
authors.forename: Andrew
authors.initials: A
authors.lastname: Gray
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Sayers
authors.forename: Anne-Louise M
authors.initials: AL
authors.lastname: Heath
authors.forename: Julie
authors.initials: J
authors.lastname: Lawrence
authors.forename: Rachael
authors.initials: R
authors.lastname: Taylor
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Taylor
mesh_terms: D000328:Adult; D001942:Breast Feeding; D003863:Depression / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008423:Maternal Age; D009520:New Zealand / Q000453:epidemiology; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000453:epidemiology; D013398:Sudden Infant Death / Q000517:prevention & control*; D016683:Supine Position