Saugstad LF. Optimality of the birth population reduces learning and behaviour disorders and sudden infant death after the first month. Acta Paediatr 1999; Suppl 429: 9-28. Stockholm. ISSN 0803-5326The weight distribution pattern of all births can be divided into a "skewing to the left" to lower weights and high neonatal mortality, a "skewing to the right" to higher weights (b3500 g) and minimum neonatal and postneonatal mortality, and a "symmetrical distribution" with mortality in between. This study was initiated with the hypothesis that a deficit in newborns of more than 3500 g would adversely affect postneonatal death. Higher and rising postneonatal mortality solely attributable to sudden infant death of unknown cause (sudden infant death syndrome; SIDS) was observed in the Nordic countries with a lower proportion of heavy newborns. Minor environmental intervention almost eliminated excess mortality from this cause, supporting raised susceptibility with a depressed birthweight in postneonatal SIDS. This contrasts with classical neonatal low birthweight SIDS, which is stable despite numerous attempts at reduction, supporting a multifactorial aetiology: low maternal age, low education, low socioeconomic status, maternal smoking, infection, etc. The postneonatal SIDS epidemic associated with a deficit in heavy newborns is thought to be a result of changing behaviour in pregnancy: moderate iatrogenic dietary restriction and young women favouring a low-calorie, low-fat diet, especially in the third trimester when the foetus is most vulnerable, which delays myelination and somatic growth and renders the infant susceptible to minor morbidity and irregularity. The timing of death and neuropathological findings suggestive of repeated hypoxic episodes in more than 80% of cases of SIDS prior to death support this theory. The similar weight distribution patterns in SIDS and all births in Denmark, the UK and the USA suggest a substantial proportion of the neonates in these countries could be growthretarded and at risk of hypoxic episodes in infancy. A few cases, particularly males (sexratio = 1.7), suffer SIDS, the majority survive. Many, mostly males, present minor CNS signs and learning and behaviour problems. The male predominance accords with males more than 500 g higher optimal birthweight than females and susceptibility to a depressed weight at birth. In order to prevent postneonatal dying, SIDS and reduce learning/behaviour disorders it is necessary to raise the proportion of heavy newborns by promoting foetal growth rate equal to the maternal intrinsic rate by eating to one's appetite a balanced diet, favouring a diet high in marine fat, especially in third trimester, in order to ensure maturation of the CNS and prolong gestation, thereby increasing birthweight. Although the increased survival of some very low birthweight neonates confounds the issue, a division between SIDS in neonatal and postneonatal death is recommended in order to assess the proportion of "avoidable infant death" as opposed to persistent clas...

The present investigation comprises all deaths in Norwegian psychiatric hospitals 1950--74: 10,413 deaths. Mortality in men declined from 361 per 10,000 before 1950 to 252 per 10,000 in 1969--74 and in women from 324 per 10,000 to 215 per 10,000 during the same periods. In the organic and symptomatic psychoses (mainly senile and arteriosclerotic) mortality ranged from six to ten times that of the general population, whereas in the non-organic (functional) psychoses mortality was only twice as high as in the general population. This discrepancy in mortality between organic and non-organic psychoses, which is caused by the somatic disorders with high lethality underlying the organic psychoses, suggests that mortality should be calculated separately for organic and non-organic psychoses, which is sometimes neglected. An increasing number of hospital admissions with organic, mainly senile, psychoses is to be expected in the future, as well as an increasing proportion of non-organic patients with slight psychotic symptoms and a low and possibly decreasing mortality. between 1950 and 1974 radical changes took place in the psychiatric hospitals which could have influenced mortality. Age-adjusted death rates from cardio-vascular diseases were actually higher in 1963--68 than in 1950--62, possibly indicating that an adverse effect of drug therapy on physical activity and somatic fitness had outweighed the stress-relieving effect. A significant rise in unnatural deaths (suicides and accidents) has been observed particularly since 1963. As in previous investigations from Norway 1926--41, cancer as cause of death was equal to or below the general population in the non-organic psychoses and somewhat higher in the organic psychoses.