Early Infant Sleep Environments: An Observational Study of New Zealand Electronic Health Data

New Zealand's post-neonatal mortality rate has remained steady at around 1.4 per 1000 live births since 2015, with Sudden Unexpected Death in Infancy (SUDI) accounting for approximately 60% of these deaths. Safe sleep guidelines are a key element of SUDI prevention but there is limited information on how these guidelines are applied in New Zealand homes. This work aims to examine safe sleep practices among New Zealand infants and explore variations based on demographic, infant and family characteristics.

This cross-sectional observational study used electronic health data for 45 969 New Zealand infants at approximately 6 weeks of age. Data came from 'Well Child/Tamariki Ora' visits conducted in 2023 by Whānau Āwhina Plunket, a provider of free health assessment and parenting support services for almost 80% of families in New Zealand. 'Safer sleep space' was defined as the exclusive use of recommended spaces (e.g., bassinet, cot, Pēpi-Pod or wahakura) and 'safer sleep position' referred to the supine (back) sleep position.

Most infants were placed in safe sleep spaces (89% day, 93% night) and positions (95% day, 96% night). The prevalence of safe sleep practices varied between regions, ethnic groups and sociodemographic groups. Higher prevalences of safe sleep practices were seen with lower socioeconomic deprivation, adequate housing, non-smoking and employed caregivers, and caregivers with greater knowledge of health and support services.

There was a high prevalence of safe sleep practices with significant variations between sociodemographic, regional and ethnic groups, providing opportunities for targeted interventions to improve infant sleep safety.