Infant death rates continue to fall

18 June 1999

Lower SIDS rates; Infant death rates continue to fall

There were fewer sudden infant death syndrome deaths (SIDS) in 1997 than previous years, though total infant deaths have moved downwards only slightly according to the latest provisional figures from the Ministry of Health.

Chief Advisor, Child and Youth Health, Dr Pat Tuohy said each one of the statistics represents a sad loss for many families and friends. Research and health promotion and education efforts continue to try and further reduce these deaths.

"These efforts are now helped by better information on the circumstances of the death and more consistent autopsy protocols," Dr Tuohy said.

Its becoming clearer that fewer infants are dying from SIDS as more accurate diagnoses and information emerges.

"Some of the fall is related to reclassification of SIDS as other diagnoses, particularly accidental suffocation, as better information is made available to pathologists and coroners". As well as some reclassification from SIDS to accidental asphyxia, the Infant death rate has not fallen as much as expected because of an increase in deaths from meningitis in 1997".

"There has been a sharp fall in numbers of babies recorded as dying from SIDS - in 1997 81 babies died from this condition down from 109 in 1996. Most of the reduction in SIDS was due to lower rates among Maori and Pacific infants. Pacific rates have halved and Maori rates have dropped by 25%," Dr Tuohy said.

"This is encouraging news, but it has to be tempered by the knowledge that two years data is too little to confirm a trend".

1996 and 1997 data for Maori and Pacific people can't be compared with pre 1995 data because of changes in the way ethnicity has been categorised.

Nontheless this information is a welcome finding and helps support the excellent work done by Maori and Pacific SIDS groups who have been working for many years to reduce SIDS in their communities, Dr Tuohy said.

This improvement follows a gradual reduction in SIDS deaths after the dramatic drop in 1990 due to the New Zealand Cot death prevention campaign.

Perinatal deaths (deaths that occur from 20 weeks of pregnancy until the first week after delivery) are believed to have increased due to better reporting over the last two years.

"There is considerable work done by many individuals and health providers in New Zealand to reduce these deaths. Better information is an important first step to ensuring our efforts are directed in the right direction," Dr Tuohy said.

The provisional 1997 figures are corrrect for total infant deaths, but there remain four deaths which have yet to have the cause of death finally determined (from post-mortem or Coroner's report), Dr Tuohy said.

BACKGROUND INFORMATION - INFANT DEATHS 1993-1997

TOTAL INFANT DEATHS
The provisional infant death rate in 1997 (6.7 per 1,000 livebirths) is the same
as in 1995 but 8 percent lower than 1996 (7.3).

INFANT DEATHS 1993-97 Numbers
|------------------+------------+------------+------------+-------------|
| | | | | |
| Year | Early NND | Late NND | Post NND | Total |
| | | | | Infant |
| | | | | |
|------------------+------------+------------+------------+-------------|
| | | | | |
| 1993 | 176 | 48 | 207 | 431 |
| | | | | |
|------------------+------------+------------+------------+-------------|
| | | | | |
| 1994 | 161 | 42 | 211 | 414 |
| | | | | |
|------------------+------------+------------+------------+-------------|
| | | | | |
| 1995 | 132 | 52 | 204 | 388 |
| | | | | |
|------------------+------------+------------+------------+-------------|
| | | | | |
| 1996 | 173 | 50 | 194 | 417 |
| | | | | |
|------------------+------------+------------+------------+-------------|
| | | | | |
| 1997 | 169 | 38 | 182 | 389 |
| (Provisional) | | | | |
| | | | | |
|------------------+------------+------------+------------+-------------|

nnd = neonatal death

(b) Rates/1000 livebirths
|------------------+------------+------------+------------+-------------|
| | | | | |
| Year | Early NND | Late NND | Post NND | Total |
| | | | | Infant |
| | | | | |
|------------------+------------+------------+------------+-------------|
| | | | | |
| 1993 | 3.0 | 0.8 | 3.5 | 7.3 |
| | | | | |
|------------------+------------+------------+------------+-------------|
| | | | | |
| 1994 | 2.8 | 0.7 | 3.7 | 7.2 |
| | | | | |
|------------------+------------+------------+------------+-------------|
| | | | | |
| 1995 | 2.3 | 0.9 | 3.5 | 6.7 |
| | | | | |
|------------------+------------+------------+------------+-------------|
| | | | | |
| 1996 | 3.0 | 0.9 | 3.4 | 7.3 |
| | | | | |
|------------------+------------+------------+------------+-------------|
| | | | | |
| 1997 | 2.9 | 0.7 | 3.2 | 6.7 |
| (Provisional) | | | | |
| | | | | |
|------------------+------------+------------+------------+-------------|

Note: There are 4 infant deaths in 1997 for which a cause of death is not yet
available; these cases are included in totals.

Apart from 1995, the numbers (and rates) of early neonatal deaths remained
relatively constant.
The numbers and rates of late neonatal (1 week to 1 month after birth) deaths
are small and should be interpreted with caution.
Numbers and rates of post-neonatal (1 month to 1 year after birth) deaths show
the greatest change. Numbers were constant from 1993-95 but have since fallen
by 11 percent. Rates have fallen by 9 percent.

SUDDEN INFANT DEATH SYNDROME (SIDS) (Y Indicator)
|-------------------------+-------------------------+-------------------------|
|YEAR |NUMBER |RATE/1000 LB |
|-------------------------+-------------------------+-------------------------|
|1993 |125 |2.1 |
|-------------------------+-------------------------+-------------------------|
|1994 |121 |2.1 |
|-------------------------+-------------------------+-------------------------|
|1995 |121 |2.1 |
|-------------------------+-------------------------+-------------------------|
|1996 |109 |1.9 |
|-------------------------+-------------------------+-------------------------|
|1997 (Provisional) |81 |1.4 |
|-------------------------+-------------------------+-------------------------|

Numbers fell by 10 percent between 1995 and 1996 and by a further 26 percent in
1997. The number of SIDS deaths in 1997 was 33 percent lower than in 1995.
Rates have also fallen. The 1997 rate was 33 percent lower than in 1995.
Preliminary analysis of the data indicates that much of the reduction in SIDS
has occurred in the Southern HFA Region where numbers fell from 26 in 1995 to 6
in 1997, a reduction of 77 percent.

Figure: Deaths from SIDS, 1988-97.
(Embedded image moved to file: pic13481.pcx)
* Provisional

Comment:

SIDS most commonly occur in the Post-neonatal period.

There are overall reductions in both SIDS and Post-neonatal deaths (PNND).
The recent reduction in SIDS is greater than the reduction in PNND. This
suggests that there may be an element of diagnostic shift but numbers are small
and we should be cautious in interpreting. Numbers of deaths coded as being due
to 'SIDS plus another diagnosis' reduced from 9 in 1994 to 3 in 1997 indicating
greater certainty about the cause of death.

More PNND were certified to infectious and parasitic diseases in 1997 than in
previous 4 years. This is primarily due to deaths from meningitis.

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