A month-old baby who died unexpectedly in 2018 had methamphetamine in her system, the Coroner says.

The report by Coroner Tania Tetitaha says Luna Mckee died in December, 2018, from sudden unexpected death in infancy with an underlying condition of meth toxicity.

Luna had woken several times during the night, which was noted as unusual for her.

The report says her mother breastfed her but fell asleep while doing so, only to awaken hours later with Luna not breathing.

A post-mortem examination found methamphetamine in Luna’s blood, and while the pathologist noted the drug could be transferred from breast milk, Luna’s mother denied any recent use.

Toxicologist Dr Leo Schlep agrees the most common route of exposure for an infant would be through breastfeeding mothers.

“The agitation that night, waking up multiple times, is a common symptom in young children poisoned with methamphetamine.”

Dr Leo Schlep believes the drug could have contributed to the baby’s death and recommended a sample of breast milk was taken in infant deaths to see if drugs were present.

During police interviews, Luna’s mother denied recent meth use, while her dad admitted using the drug but couldn’t recall how many times he’d smoked it after his daughter’s birth.

He denies the possibility of cross-contamination with Luna’s milk formula and said he kept the drug in a “Systema click plastic container” stored in a safe.

Police didn’t take a sample of the formula for testing.

There was “insufficient evidence” on how Luna ended up with meth in her system, Coroner Tetitaha says, but notes there is a link between infant deaths and exposure to the drug.

To prevent more deaths Coroner Tetitaha says harm reduction strategies that seek to reduce harm to infants by adult meth use should receive priority.

She also notes police should take samples of food including formula and breast milk when an infant death occurrs in the context of adult drug use.

“There may also be a trend emerging unexplained infant deaths may have been connected to adult meth use.”

Coroner Tetitaha suggests Te Whatu Ora should monitor those trends through the Coroner’s office.

She recommends Te Whatu Ora consider funding Te Ara Oranga, a meth harm reduction programme, throughout the country, along with monitoring trends.

While police should consider drafting a protocol for similar deaths and make sure samples are taken.

Te Whatu Ora notes it has received $3.5 million of funding to expand Te Ara Oranga.

“Any further investment is at the discretion of the health minister,” it says.

Te Whatu Ora says it “welcomed” the opportunity to work with the Coroner’s office to monitor trends.

Police tells the Coroner they didn’t consider it necessary to draft a protocol as there was already guidance and policy in existence.