 Kia ora, maenai maeniria Mali McFarlane a ni maeniria anau ma expandiku te wakaret ka tu maeniria maeniria pweseb ca maeni pwedei kuca-apatwa pediatrax Prof Edmitchill maeniria rata i nt maori maeniria zinama Maeni 3 rana pwedei te maeniri Jack being the first boy is adored by his parents, his sisters and his wider whānau. Most of the time, Jack sleeps in his own cot in his mum and dad's room. Sometimes at night after a feed, if it's really cold or if Mary Jane is really tired, Jack will sleep in bed with his mum and dad. Just like his sisters did before him. One morning after such a night, Mary Jane woke up and reached out to cuddle Jack. He noticed that his face and lips were cold and he was unresponsive. Jack had died while his mum and dad slept in the bed beside him. Now Mary Jane is not an actual person, but she does represent the parents of the 40 to 50 babies each year in New Zealand, who die suddenly and unexpectedly, usually during sleep and initially without explanation. Suri is an acronym for sudden unexpected death and infancy. It used to be known as cot death or SIDS, but Suri is a broader term because it includes unexplained deaths, as well as those for which an actual or possible cause can be identified. The key thing is that a Suri death is sudden and unexpected. It occurs in an infant under one year of age and even after a thorough investigation, a cause may or may not be found. In New Zealand, we have seen a reduction in Suri rates over the past five to six years. However, we still have the highest rate among developed countries. Suri continues to be a leading cause of infant mortality in this country and Māori infants are over-represented in these statistics. So why is it that Māori infants are more likely to die from Suri compared to non-Māori? The New Zealand cot death study, which was undertaken in the late 1980s by Professor Mitchell, looked at this and found that the difference could be explained by the higher exposure among Māori infants to smoking and pregnancy and to bed sharing. Bed sharing is when another person, adult or child, is asleep on the same sleep surface as the baby, whether that be a bed, a couch or a mattress on the floor. In New Zealand, more than half of all Suri deaths occur in a bed sharing situation. Part of my research involves looking at that disparity between Māori and non-Māori Suri from a contemporary perspective. And to do this, I've drawn on data from the Suri nationwide study. So this study used a prospective case control design. We implemented the study across New Zealand over a three-year period from March 2012 through to February 2015. Now in New Zealand, all sudden unexpected or unnatural deaths are referred to a coroner and these include Suri cases. During our study, we had 137 Suri cases referred to a coroner and these became our case group. Of these, we interviewed 133, which was equal to a 97% response rate. Infants in the control group were randomly sampled and then selected by district health boards from their hospital birth registers. And of these, 258 or 40% of parents that were selected were interviewed for the control group. Data was collected—a data were collected through face-to-face interviews with cases and controls, usually with mothers. And these interviews were based on detailed health-focused questionnaires. We also collected a set of photographs of sleep scene reconstruction using a cloth doll. For example, the photograph on the left shows the position that the baby was placed to sleep and the photograph on the right shows the position of the baby when they were found awake or for cases found unresponsive. These photos are from a control set. So during the study, Māori unsurprisingly had the highest Suri rate of 1.37 deaths for every 1,000 live births and this is compared to the much lower rate for non-Māori of 0.53. The New Zealand hot-death study identified smoking and pregnancy and bed-sharing as key risk factors for Suri more than 25 years ago. We used odds ratios to determine the effect of these risk factors on an infant's risk of Suri today. Smoking and pregnancy led to a six times greater increase in the risk of Suri for an infant and bed-sharing led to an almost five times greater increase in the risk of Suri. Interestingly, the effect of these two factors did not differ between Māori and non-Māori. So that's relevant and we're going to come back to that point. There were differences in prevalence, however, particularly around smoking and pregnancy and you can see in the case results over there Māori mothers were more likely to smoke at 87%. We compared to just 62% for non-Māori and in the control group Māori mothers were twice as likely to smoke at 47% compared with just 23% for non-Māori. Now bed-sharing, on the other hand, was practiced relatively equally by Māori and non-Māori in the case group and Māori and non-Māori in the control group. In fact, you can see that there is just a two to three percent difference in prevalence within these two groups. We looked at the way the two factors interact with each other and what that meant for an infant's risk of Suri and we found that infants exposed to both factors were at a 32 times greater increased risk of Suri compared to an infant that was not exposed to smoking and pregnancy and not exposed to bed-sharing. Again, that effect of the interaction did not differ between Māori and non-Māori. So what does that all mean? Well, we know that smoking and pregnancy and bed-sharing continue to represent a risk to infants today for Suri. We know that the individual risk factors don't differ in terms of how they affect infants so it's the same regardless of ethnicity. Likewise, with that interaction, we know that the two factors combined amplify that risk but again that relationship was no different between Māori and non-Māori. So what was different? The prevalence of smoking among Māori is the biggest difference but what it means is that Māori infants are more likely to be exposed to both factors so to the dangerous combination of smoking and pregnancy and to bed-sharing. So what can we do about this? Well, preventing the risk would be the ideal approach by not smoking. However, for mums that did smoke during pregnancy, a pragmatic approach would be to enable and promote infant safe sleep for that mum, for those mothers. Now infant safe sleep is not a new message. However, there has been a groundswell in recent years regarding the promotion and availability of safe sleep devices such as the traditionally woven flax wahakura that's led by Professor Tepinir Leach and the plastic version called a pepi pod which was developed by Stephanie Cohen following the 2011 Canterbury earthquakes. Safe sleep devices enable infants to bed-share safely while still maintaining that closeness and the easy accessibility for breastfeeding. Also, the Ministry of Health have just funded a National Suri Prevention Program which features these devices. So just going back to that disparity, we know that the difference can continue to be explained by the higher exposure among Māori infants to smoking and pregnancy. But just putting aside ethnicity and smoking status, the message that I'd like to leave you with today is that the most important thing is to support and encourage and enable families to make sure that every sleep is a safe sleep for baby. Thank you so much.