NICOTINE AND COTININE LEVELS IN PERICARDIAL FLUID IN VICTIMS OF SIDS

We have analyzed the levels of nicotine and cotinine in pericardial fl uid in 24 consecutively autopsied cases of sudden unexpected death in infants aged one to six months. Our aim was to determine to what exten t victims of sudden infant death may have been exposed to passive smok ing near the time of death. Sixteen of the decreased infants were clas sified as SIDS at autopsy. Other contributing causes of death, predomi nantly infections, were found in eight cases. Eight infants (30%) had cotinine levels less than 2 ng, indicating that no significant exposur e to nicotine had occurred near the time of death. Of the remaining 70 %, five had been moderately exposed, seven markedly exposed and four h eavily exposed (cotinine levels 2-10 ng, 10-50 ng and more than 50 ng, respectively). Since only 18% of Swedish women smoke after childbeari ng we conclude that nicotine exposure in infants who died suddenly was much higher than one would otherwise expect. It is hypothesized that high concentrations of nicotine and nicotine metabolites around the he art may affect cardiac function and thus play a role in the mechanisms causing SIDS or other categories of sudden unexpected death.