J. Milerad et al., OBJECTIVE MEASUREMENTS OF NICOTINE EXPOSURE IN VICTIMS OF SUDDEN-INFANT-DEATH-SYNDROME AND IN OTHER UNEXPECTED CHILD DEATHS, The Journal of pediatrics, 133(2), 1998, pp. 232-236
Objective: Self-reported maternal smoking is associated with a dose-re
lated increase in the risk of sudden infant death syndrome (SIDS). The
aim of this study was to measure objectively whether victims of SIDS
are more exposed to tobacco smoke before death than infants who die un
expectedly of other causes. Design: Cotinine levels in pericardial flu
id were used as an indicator of exposure. Levels > 5 ng/mL indicated s
ignificant exposure, and levels > 20 ng/mL indicated heavy exposure. S
amples were obtained from all sudden deaths in children < 7 years of a
ge that occurred from 1990 through 1993 in southeastern Norway. Twenty
-four infants died of SIDS, 12 infants of infections, and 9 of acciden
ts (median age 4.5, 5, and 35 months, respectively). Results: Compared
with the age-matched infectious deaths, a significantly higher propor
tion of victims of SIDS had been significantly (92% vs 67%) or heavily
exposed (25% vs 0%) to nicotine, (P < .05). Median cotinine levels in
infants with SIDS, 15.8 ng/mL, were significantly higher than in infa
nts who had infectious deaths 7.1 ng/mL (P < .003) but were comparable
to those of accident victims (12.9 ng/mL, not significant). Conclusio
ns: Victims of SIDS are more often and more heavily exposed to tobacco
smoke doses before death than are infants who have sudden infectious
deaths. Accidental death in infancy and childhood is often associated
with a significant exposure to nicotine.