A large literature has linked “in utero” environment to health and socio-economic outcomes in adulthood. We consider the effect of early life environments on health and skill formation outcomes. We first evaluate the impact of perinatal-neonatal level of technology at birth, which varies across delivery institutions, on the long-term neurodevelopmental outcomes of children with Cerebral Palsy. The level of technology at delivery determines the type of therapy newborns receive immediately after birth. The type of therapy is critical to prevent or treat adverse events around labor and delivery which determine later neurological and neurocognitive impairments such as CP. We evaluate the relationship between availability of neonatal technology, which is associated with levels of care at delivery hospitals, and CP nonambulatory status, using data from the Canadian Multi-Regional Cerebral Palsy Registry. In a follow-up paper we further explore the efficiency of neonatal transfers across Quebec neonatal system. We find robust evidence that there is no statistical significant relationship between level of neonatal care at birth and CP severity. This finding means that differences in levels of neonatal care and associated technology available at delivery are not associated at the margin with the risk of a non-ambulatory CP phenotype among children with CP. Overall we conclude that, in the Quebec regionalized neonatal care system, there is no gain to increasing the level of care assigned to mothers at risk of CP. We estimate the effect of mothers’ participation in the Supplementary Nutrition Assistance Program and the Special Supplemental Nutrition Program for Women, Infants, and Children on early cognitive and non-cognitive developmental outcomes as measured by the Bayley Scales of Infant Development. Our data are from a large, prospective, community-based panel study of mother-infant pairs. In this rich data set we can directly identify the change in neurodevelopmental outcomes associated with changes in food programs uptake. In a model where unobserved heterogeneity only affects the level of neurodevelopmental outcomes this can be interpreted as a causal effect. Our results suggest that brief prenatal investments may be more cost effective than traditional educational interventions in improving early childhood developmental outcome.
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Thesis advisor: Pendakur, Krishna
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