Cot-death: the ammonia factor.

Wet nappies at night could cause infants at risk to die. Tyler first suspected this ten years ago when his head was jerked back from his infant son's cot by the pungent odour of ammonia gas. This theory is consistent with the full epidemiology of cot-death. Ammonia is an insidious poison which has a wide and varied range of effects on the respiratory and nervous systems according to concentration and length of exposure. At its mildest it irritates the tissues. In larger doses ammonia can cause pulmonary oedema and pneumonitis. It can also cause stenosis of affected organs. Its chief danger lies in its potential to disrupt oxygenation at every level throughout the body. Acute and chronic poisoning profiles indicate the possibility that numbers of infants reported as dying from gastro-intestinal or respiratory disease could have been ammonia poisoning victims. Predisposing factors, such as smoking during pregnancy, are shown to contribute to the vulnerability of the infant to ammonia poisoning. The theory provides the framework for the development of an effective programme of infant death prevention.