Secondhand smoke and SIDS

Milerad's study does not show that secondhand smoke is associated with SIDS.

Milerad's results are based on comparing 24 SIDS deaths with 12 infant deaths caused by infection. This sample of deaths was selected from all sudden deaths in children occurring in southeastern Norway during 1990-1993.

Aside from concerns of small size and sampling bias, the children who died from infections were probably either hospitalized or in nonsmoking environments. So they were less likely to be exposed to tobacco smoke. SIDS occurs in apparently healthy children, so there is no surprise that higher levels of cotinine will be found since smoking is less likely to be avoided around apparently healthy children.

My hypothesis is bolstered by Milerad's data about children who died from accidental causes -- more healthy children. Cotinine levels among the accidental deaths was comparable to levels among the SIDS deaths.

And let's not forget there is no biological mechanism offered that supports Milerad's secondhand smoke-SIDS link.

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