In Reply.—We thank Dr Bass for his thoughtful comments. He raises two issues related to the legitimacy of SIDS as a specific clinical entity. As suggested by death scene investigations,1 he argues that most deaths can be explained by accidental or intended circumstances rather than caused by an underlying pathophysiological abnormality. He also suggests that aberrant home conditions may be an even more likely cause of (explained) death in infants with prenatal cocaine exposure.
We agree that an autopsy that reveals normal findings may not exclude suffocation as the cause of death. Although our study focused only on living infants and the increased incidence of cardiorespiratory pattern abnormalities following prenatal cocaine exposure,2 there are other studies that do document an increased SIDS rate in infants with prenatal cocaine exposure.2,3 These families may indeed be high risk in numerous ways, but there is no evidence to suggest