Sudden infant death syndrome: postmortem findings of nicotine and cotinine in pericardial fluid of infants in relation to morphological changes and position at death.

Parental smoking is considered to be an important risk factor for the sudden infant death syndrome (SIDS). We studied the concentrations of nicotine and cotinine in the pericardial fluid of SIDS and non-SIDS victims, with particular emphasis on the relationship to body position at the time of death and organ pathology. Pericardial fluid was collected during a forensic postmortem examination of 85 nonselected infants, under the age of 1 year, who died from SIDS (n = 67) and non-SIDS (n = 18) in the period from 1988 to 1994. There was no significant difference in the pericardial concentration of nicotine and cotinine between SIDS and non-SIDS victims. However, in contrast to non-SIDS victims, about 25% of the infants in the SIDS group had cotinine concentrations exceeding 30 ng/mL, indicating tobacco exposure prior to death. High concentrations of cotinine were found in infants with focal necrosis and inflammatory changes in the myocardium and the liver. Further, a relationship was found between high nicotine concentration and otitis media and also with death while cosleeping.