PROJECT SUMMARY The Division of Neonatal and Developmental Medicine at Stanford University submits a competing renewal application to participate in the NICHD Neonatal Research Network (NRN). The Division and its faculty members have a long history of innovative research accomplishments in neonatal medicine. This expertise dovetails with the NRN goal of conducting definitive and rigorous multicenter trials and observational studies in newborns to improve survival without neurodevelopmental impairment. As a participant in the NRN since 1991, this center has proven to be highly productive, contributing to leadership, study design, protocol development, execution, analysis, and results dissemination. Led by PI, Krisa Van Meurs, Alternate PI, Valerie Chock, and Follow-up PI, Susan Hintz, the site neonatologists and subspecialty collaborators have wide-ranging expertise and significant clinical research experience with 613 manuscripts published in neonates since 2016. Within the NRN, Stanford investigators have 55 subcommittee assignments and appear as co-authors 117 times on NRN manuscripts. Dr. Van Meurs is Chair of the Publications Committee and coordinated 131 manuscript reviews, spearheaded a review of NRN policies leading to a reduction in time to publication, and was Editor for the Seminars in Perinatology volume describing NRN contributions over the last grant cycle. As Lead Follow-up PI and Chair of Follow-up Protocol Development, Dr. Hintz has been responsible for advancing protocols and proposals, and assuring the quality of NRN follow up visits, and enhancing rigor of training and certification procedures. During the COVID pandemic she led re-envisioning of certification processes, launched new tools, and developed individualized improvement plans for challenged sites. Cody Arnold is Co-PI for the ongoing Cycled Phototherapy trial. Valerie Chock led a NHLBI-funded secondary to the Transfusion in Prematures trial on near-infrared spectroscopy (NIRS), Dr. Van Meurs led a secondary to the Optimizing Cooling trial on amplitude-integrated EEG, and Courtney Wusthoff led a secondary study to the Preemie Hypothermia trial on EEG. Stanford neuroradiologists have been MRI central readers for all the NRN cooling trials. The Stanford site with its 2 satellite sites, El Camino Hospital and Santa Clara Valley Medical Center, provide an annual delivery base of >12,000 births with 59% born to high risk mothers, 140 NICU beds, and >1900 NICU admissions with 83% inborn. Two sites anticipate growth in deliveries over the next 3 years. Our aggregate population is diverse in comparison to the rest of the US with 25% Asian and 52% Hispanic. Over the last 6 grant cycles Stanford has demonstrated wide-ranging expertise, exceptional leadership, and strong collaborative abilities that have served the NRN well. One of the greatest strengths Stanford has to offer is our extensive and talented pool of young clinical investigators that will become the clinical research...