International Journal of Legal Medicine

, Volume 122, Issue 1, pp 23–28 | Cite as

Nicotine and cotinine in infants dying from sudden infant death syndrome

  • T. Bajanowski
  • B. Brinkmann
  • E. A. Mitchell
  • M. M. Vennemann
  • H. W. Leukel
  • K.-P. Larsch
  • J. Beike
  • the GeSID Group
Original Article


The aim of this component of the German Study on Sudden Infant Death was to determine (1) nicotine concentrations in hair (NCH), as a marker of long standing exposure to tobacco, (2) cotinine concentrations in pericardial fluid (CCP) and (3) cotinine concentrations in liquor cerebrospinalis (CCL), the latter measures being markers of recent exposure to tobacco in the last few hours of life. The results obtained were compared with data on parental smoking revealed from interviews. In 100 cases of sudden infant death syndrome, material was taken at autopsy to determine NCH. In 41 cases, NCH and CCP, and in 70 cases, NCH and CCL were determined. Infants of mothers who stated having smoked during pregnancy had higher NCH than infants of non-smoking mothers (p = 0.008). Furthermore, there was a weak but statistically significant relationship between NCH’s and the daily cigarette consumption of the mother during pregnancy (n = 64, r = 0.24, p = 0.05). In 43% of infants, nicotine could be detected in their hair, although the mothers had said at the interview that they did not smoke during pregnancy. On the other hand, in 33% of infants whose mother stated they had smoked during pregnancy nicotine was not detectable in the infant’s hair. CCP’s were strongly correlated with CCL’s (r = 0.62, p = 0.0027). For this reason, both parameters were treated as equivalent for the detection of tobacco smoke exposure in the last hours before death. The influence of breast-feeding was evaluated by comparison of the nicotine concentrations in breast fed and non-breast-fed infants from smokers and non-smokers. Fivefold higher nicotine concentrations were determined in non-breast-fed infants of parents who smoked as compared to all other groups. It can be concluded that nicotine intake by passive smoking is much more important than by breast-feeding. We conclude that both interview data and biochemical measures should be sought to understand the true exposure to tobacco smoke.


Sudden infant death syndrome (SIDS) Smoking Nicotine Cotinine Breast feeding 



The study is supported by the Federal German Ministry for Science and Education (01 ED 9401/8). We thank E. Müller who worked as recorder. We also thank the 32 interviewers, who undertook interviews during the 3 years of the study, and Schwertner Field Research, Augsburg, for performing the fieldwork. EA Mitchell is supported by the Children Health Research Foundation. Most importantly, the authors are indebted to the parents who participated in this study.


  1. 1.
    Statistisches Bundesamt Deutschland (2006)
  2. 2.
    Jorch G, Schmidt-Troschke S, Bajanowski T, Heinecke A, Findeisen M, Nowack C, Rabe G, Freislederer A, Brinkmann B, Harms E (1994) Epidemiologische Risikofaktoren des plötzlichen Kindstodes. Ergebnisse der westfälischen Kindstodsstudie 1990-1992. Monatsschr Kinderheilkd 142:45–51Google Scholar
  3. 3.
    Findeisen M, Jorch G (1991) Plötzlicher säuglingstod: epidemiologische daten. Dokumentationsband Expertenhearing; MAGS-NRW, DüsseldorfGoogle Scholar
  4. 4.
    Mitchell EA, Scragg R, Stewart AW et al (1991) Cot death supplement: results from the first year of the New Zealand cot death study. NZ Med J 104:71–76Google Scholar
  5. 5.
    De Jonge GA, Engelberts AC, Koomen-Liefting AJM, Kostense PJ (1989) Cot death and prone sleeping position in The Netherlands. BMJ 298:722PubMedGoogle Scholar
  6. 6.
    Fleming PJ, Gilbert R, Azaz Y et al (1990) Interaction between bedding and sleeping position in the sudden infant death syndrome: a population based case control study. BMJ 301:85–89PubMedGoogle Scholar
  7. 7.
    Beal S (1989) Sleeping position and SIDS. Lancet 2:512Google Scholar
  8. 8.
    Dwyer T, Ponsonby AL, Couper D (1999) Tobacco smoke exposure at one month of age and subsequent risk of SIDS—a prospective study. Am J Epidemiol 149:593–602PubMedGoogle Scholar
  9. 9.
    Schlaud M, Kleemann WJ, Poets CF, Sens B (1996) Smoking during pregnancy and poor prenatal care: two major preventable risk factors for sudden infant death syndrome (SIDS). Int J Epidemiol 25:959–965PubMedCrossRefGoogle Scholar
  10. 10.
    Findeisen M, Vennemann M, Brinkmann B, Ortmann C, Röse I, Köpcke W, Jorch G, Bajanowski T (2004) German study on sudden infant death (GeSID): design, epidemiological and pathological profile. Int J Legal Med 118:163–169PubMedCrossRefGoogle Scholar
  11. 11.
    Cheron G, Timsit S (2003) Smoking and sudden infant death syndrome. J Gynecol Obstet Biol Reprod (Paris) 32:1S33–1S40Google Scholar
  12. 12.
    Milerad J, Rajs J, Gidlund E (1994) Nicotine and cotinine levels in pericardial fluid in victims of SIDS. Acta Paediatr 83:59–62PubMedGoogle Scholar
  13. 13.
    Milerad J, Vege A, Opdal SH, Rognum TO (1998) Objective measurements of nicotine exposure in victims of sudden infant death syndrome and in other unexpected child deaths. J Pediatr 133:232–236PubMedCrossRefGoogle Scholar
  14. 14.
    Paulson GW, Olson BL (1995) Can smoking be detected from cerebrospinal fluid? Clin Neuropharmacol 18:375–376PubMedCrossRefGoogle Scholar
  15. 15.
    Mercelina-Roumans PE, Schouten H, Ubachs JM, van Wersch JW (1996) Cotinine concentrations in plasma of smoking pregnant woman and their infants. Eur J Clin Chem Clin Biochem 34:525–528PubMedGoogle Scholar
  16. 16.
    Bajanowski T, Fürst P, Wilmers K, Beike J, Köhler H, Karger B, Brinkmann B (2002) Dioxin concentrations in infant tissue and sudden infant death. Int J Legal Med 116:27–32PubMedCrossRefGoogle Scholar
  17. 17.
    Bajanowski T, Vennemann M, Bohnert M, Rauch E, Brinkmann B, Mitchell EA, the GeSID Group (2005) Unnatural causes of sudden unexpected deaths thought initially to be SIDS. Int J Legal Med 119:213–216PubMedCrossRefGoogle Scholar
  18. 18.
    Zahlsen K, Nilsen OG (1994) Nicotine in hair of smokers and non-smokers: sampling procedure and gas chromatographic/mass spectrometric analysis. Pharmacol Toxicol 75:143–149PubMedCrossRefGoogle Scholar
  19. 19.
    Armitage AK, Dollery CT, George CF et al (1975) Absorption and metabolism of nicotine from cigarettes. Brit Med J 4:313–316PubMedGoogle Scholar
  20. 20.
    Benowitz NL, Jacob P (1994) Metabolism of nicotine to cotinine studies by a dual stable isotope method. Clin Pharmacol Ther 56:483–493PubMedCrossRefGoogle Scholar
  21. 21.
    Kintz P, Ludes B, Mangin P (1992) Evaluation of nicotine and cotinine in human hair. J Forensic Sci 37:72–76PubMedGoogle Scholar
  22. 22.
    Eliopoulos C, Klein J, Phan MK, Knie B, Greenwald M, Chitayat D, Koren G (1994) Hair concentrations of nicotine and cotinine in women and their newborn infants. J Am Med Assoc 271:621–623CrossRefGoogle Scholar
  23. 23.
    Pichini S, Altieri I, Pellegrini M, Pacifici R, Zuccaro P (1997) The analysis of nicotine in infant’s hair for measuring exposure to environmental tobacco smoke. Forensic Sci Int 84:253–258PubMedCrossRefGoogle Scholar
  24. 24.
    Eliopoulos C, Klein J, Koren G (1996) Validation of self-reported smoking by analysis of hair for nicotine and cotinine. Ther Drug Monit 18:532–536PubMedCrossRefGoogle Scholar
  25. 25.
    Eliopoulos C, Klein J, Phan MK, Knie B, Grennwald M, Chitayat D, Koren G (1994) Hair concentrations of nicotine and cotinine in women and their newborn infants. JAMA 271:621–623PubMedCrossRefGoogle Scholar
  26. 26.
    Nafstad P, Botten G, Hagen JA, Zahlsen K, Nilsen OG, Silsand T, Kongerud J (1995) Comparison three methods for estimating environmental tobacco smoke exposure among children aged between 12 and 36 months. Int J Epidemiol 24:88–94PubMedCrossRefGoogle Scholar
  27. 27.
    Sachs H (1995) Theoretical limits of the evaluation of drug concentrations in hair due to irregular hair growth. Forensic Sci Int 70:53–61PubMedCrossRefGoogle Scholar
  28. 28.
    Dahlstrom A, Ebersjo C, Lundell B (2004) Nicotine exposure in breastfed infants. Acta Paediatr 93:810–816PubMedCrossRefGoogle Scholar
  29. 29.
    Amir LH, Donath SM (2003) Does maternal smoking have negative physiological effect on breastfeeding? The epidemiological evidence. Breastfeed Rev 11:19–29PubMedGoogle Scholar
  30. 30.
    Rylander E, Pershagen G, Eriksson M, Bergmann G (1995) Parental smoking, urinary cotinine, and wheezing bronchitis in children. Epidemiology 6:289–293PubMedCrossRefGoogle Scholar
  31. 31.
    Stepans MB, Wilhelm SL, Dolence K (2006) Smoking hygiene: reducing infant exposure to tobacco. Biol Res Nurs 8:104–114PubMedCrossRefGoogle Scholar
  32. 32.
    Cheron G, Timsit S (2003) Smoking and sudden infant death syndrome. J Gynecol Obstet Biol Reprod (Paris) 32:1S33–1S40Google Scholar
  33. 33.
    Fauroux B (2003) Smoking, fetal pulmonary development and lung disease in children. J Gynecol Obstet Biol Reprod (Paris) 32:1S17–1S22Google Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • T. Bajanowski
    • 1
  • B. Brinkmann
    • 2
  • E. A. Mitchell
    • 3
  • M. M. Vennemann
    • 2
  • H. W. Leukel
    • 4
  • K.-P. Larsch
    • 5
  • J. Beike
    • 2
  • the GeSID Group
  1. 1.Institute of Legal Medicine, University Hospital EssenUniversity of Duisburg-EssenEssenGermany
  2. 2.Institute of Legal MedicineUniversity of MünsterMünsterGermany
  3. 3.Department of PaediatricsUniversity of AucklandAucklandNew Zealand
  4. 4.Institute of Legal MedicineUniversity of FrankfurtFrankfurtGermany
  5. 5.Institute of Legal MedicineHannover Medical SchoolHannoverGermany

Personalised recommendations