BMJ Press Releases, Saturday 27 July 1996
Volume 313 No 7051

EMBARGOED 00.01 HRS 26 JULY 1996

COT DEATH STUDY REVEALS FURTHER RISK FACTORS AND PROVIDES "STRONGEST EVIDENCE" OF THE RISK OF COT DEATH AND SMOKING

[Smoking and the sudden infant death syndrome: results from 1993-5 case-control study for confidential inquiry into stillbirths and deaths in infancy]

[Environment of infants during sleep and risk of the sudden infant death syndrome: results of 1993-5 case-control study for confidential inquiry into stillbirths and deaths in infancy]

Nearly two thirds of cot deaths may have been prevented if the mother had not smoked during pregnancy or if the baby had not been subjected to the effects of tobacco smoke from others before or after birth, according to a study in this week's BMJ

The study is the first of its kind since the 1991 UK "Back to Sleep" cot death (or sudden infants death syndrome) campaign which led to a reduction in the numbers of unexpected deaths among babies. Despite its success cot death remains a major cause of death in infancy. The campaign advised parents to place babies on their back or side to sleep, to avoid overheating and smoky environments, and to contact a doctor if their baby was unwell. The Department of Health will this week issue a new leaflet to advise parents further.

Researchers studied 195 cases of cot death in the Yorkshire, South West and Trent NHS regions during 1993-5 (covering a total population of about 17 million) and compared results with 780 similar cases of babies who survived.

They claim the results provide the "strongest evidence to date" of a link between cot death and smoking. They say exposure to tobacco smoke from other members of the household, before or after birth, increased the risk of death and that the greater the exposure the higher the risk. They found more than 60 per cent of deaths may have been due to exposure to tobacco smoke from the mother and others before and after birth.

The results also make the important observation that cot death was higher in infants placed to sleep on their side than on their backs. Other environmental risk factors such as allowing the baby to sleep on its front, loose bedding (particularly duvets) which can slip over the baby's head and bed sharing by mothers who smoke were confirmed in the study.

In addition to not smoking researchers say that risks of avoiding cot death may also be reduced by allowing the baby to sleep on its back with its feet at the foot of the cot, ensuring that bedding is securely tucked in and by not using duvets.

Contact: Prof Peter Fleming
Professor of infant health and developmental physiology

Foundation for the Study of Infant Deaths Research Unit
Royal Hospital for Sick Children
Bristol
B52 8BJ

Tel: 0117 928 5134
Fax: 0117 929 2914

or

Iain Smith
Paediatrician

Nuffield Institute for Health
University of Leeds

Tel: 0113 233 4868

STUDIES FIND NO LINK BETWEEN VITAMIN K INJECTIONS AND CHILDHOOD CANCER

[Childhood leukaemia and intramuscular vitamin K: findings from a case-control study]

[Vitamin K and childhood cancer: a population based case-control study in Lower Saxony, Germany]

Two studies in this week's BMJ fail to support earlier research which claimed to have found a link between injections of vitamin K given to newborn babies and the subsequent development of childhood leukaemia.

Vitamin K was given routinely to babies to prevent bleeding and is necessary for blood clotting. The two studies, from Oxford in the UK and Lower Saxony, Germany, say their research does not support evidence by Golding et al in 1992 which claimed to have identified a link from research done at two Bristol hospitals. It showed the incidence of cancer in children who had received vitamin K at birth was twice that of children who had received either no vitamin K or an oral dose only and it sparked worldwide concern.

The German study examined 272 children with leukaemia and other tumours and compared them with 334 children who were not suffering from cancer. The research was carried out as a part of a study to explore possible causes of childhood cancer in Lower Saxony and researchers say their study size was sufficient to detect a cancer risk of at least 1.55. The children were born in 162 different obstetrics hospitals from 1975-1993 when only one vitamin K preparation - the same as used in the Golding study - was licensed for neonatal vitamin K prophylaxis (treatment). The records were critically assessed and they found no association between the injection of vitamin K and subsequent development of cancer.

Oxford researchers examined data compiled from case notes of children aged 0-14 at three hospitals in Oxford, Reading and Cambridge. They also found no association between vitamin K injections and the development of childhood leukaemia. Both studies conclude that their results support other studies from around the world which have also failed to confirm Golding's findings.

Contacts: (Oxford study)

Dr Eve Roman
Senior Scientist

Leukaemia Research Fund
Clinical Epidemiology Unit
Leeds L52 NG

Tel: 0113 244 3517
Fax: 0113 242 6065
E-Mail: e_roman@ICRF.ICNET.UK

or

Prof Rudiger von Kries
Paediatric epidemiologist

Institute for Social Paediatrics and Adolescent Medicine
Ludwig-Maximilians-University
Heiglhofstr 63
81337 Munich
Germany

Tel: 00 49 89 71 00 9 3 14
Fax: 00 49 89 71 00 93 15
00 49 89 71 00 92 48

EDITORIAL
[Vitamin K at birth. Haemorrhagic disease of the newborn can be eradicated without risk of leukaemia or cancer]

An accompanying editorial puts the controversy into international context. It points out that in response to the concerns the British Paediatric Association recommended in 1992 that newborn infants receive vitamin K orally rather than by injection, although there were later fears about the oral vitamin K when five reports of late haemorrhagic disease in infants who received oral vitamin K at birth were reported. Several studies from the USA, Denmark and Sweden suggested that there was no relation between vitamin K administration in newborn babies and the development of childhood cancer or leukaemia. The author says that the publication of this week's BMJ studies should "allay our fears and doubts" about the dangers of administering vitamin K by injection immediately after birth. "It seems that haemorrhagic disease of the newborn can be completely eradicated without the threat of leukaemia and childhood cancer as a side effect."

Contact: Alvin Zipursky

Division of Haematology and Oncology
Hospital for Sick Children and the University of Toronto
Ontario, Canada

Tel: 001 416 813 7742
Fax: 001 416 813 5327

Will to win too strong to stamp out drug taking in sport

[Education and Debate. Fortnightly Review. Drugs in sport]

Drug taking in sport cannot be stamped out as some athletes will always seek competitive advantage. It can only be controlled if the chances of detection are likely and the penalties a sufficient deterrent, concludes a paper in this week's BMJ

Although the full extent of the problem is not known figures from the 23rd Olympiad in Los Angeles showed 1.7 per cent of 1,510 samples taken contained a banned drug. In 1986 at the 10th Asian games the figure was 3.2 per cent and at the 1988 Winter Olympics 2.6 per cent. Data from dope testing in the United Kingdom can be compared South Africa where during 1986-91 5.5 per cent of 2,066 urine specimens collected from competitors contained drugs classified as forbidden by the International Olympic Committee.

Contact: Domnhall MacAuley
Editor
British Journal of Sports Medicine

contact via
Hillhead Family Practice
Belfast, BT11 9FZ

Tel: 01232 613712
Fax: 01232 602944

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