PROJECT SUMMARY This proposal is a reapplication from the University of Texas Southwestern (UTSW) Medical Center to participate as a clinical center in the Eunice Kennedy Shriver NICHD Neonatal Research Network (NRN). Myra Wyckoff, MD became Principal Investigator (PI) in September 2013 and will remain as PI. Luc Brion, MD and Roy Heyne, MD will continue to serve as Alternate PI and Follow-up PI, respectively. As an NRN clinical center since 1986, UTSW has the necessary academic, research and clinical infrastructure to assure continued rigor and reproducibility for NRN studies (Aim 1). UTSW Neonatal-Perinatal Medicine (NPM) Faculty have broad experience in translational and multi-center, randomized clinical trials with the NRN and other networks and will contribute to NRN concept proposals, studies, and publications. As an international leader in newborn resuscitation science, Dr. Wyckoff will provide the NRN with expertise on issues of perinatal transition, stabilization and resuscitation following birth. Other faculty will bring expertise in Neuro-Neonatal Intensive Care and hypoxic-ischemic encephalopathy (Dr. Chalak), oxygen use in the delivery room (Dr. Kapadia), placental effects on the fetus (Dr. Leon), gut microbiome (Dr. Mirpuri), breast milk and nutritional elements (Dr. Brion), use of clinical informatics for research (Dr. Lehman) and effects of perinatal interventions on metabolic syndrome and neurodevelopment (Dr. Heyne). UTSW will work to support trials from a wider range of investigators both within UTSW but also from investigators outside the core NRN centers (Aim 2) and to leverage resources for wider sharing of data and biospecimens (Aim 3). The NPM Division has consistent strong support from the UTSW Pediatric Department as well as its clinical facilities, Parkland Memorial Hospital (PMH), UTSW Clements University Hospital (CUH) and Children’s Medical Center (CMC) of Dallas. PMH has one of the largest inborn delivery services in the United States with ~12,000 births per year. CUH has a growing delivery service with a significant focus on high risk pregnancies and a state-of-the art facility. The CMC NICU is one of the largest referral units in the region and continues to expand its reach through telemedicine. The Obstetric Department at UTSW has active referral and research programs across all clinical sites which ensures that high-risk pregnant women deliver on our campus. The patient population at PMH and CUH is predominantly under-represented minorities of Hispanic ethnicity and/or Black/African-Americans. Their inclusion in clinical trials is essential to reduce frequent health disparities (Aim 4). A high percentage of eligible infants at UTSW clinical sites are enrolled in randomized trials. Protocols are meticulously followed and complete data is obtained. Follow-up of study infants is integrated within the infant’s primary medical home at CMC, and follow-up rates are among the highest in the NRN. Thus, UTSW has much to o...