Project Summary The University of Iowa submits this renewal application for continued participation in the NICHD Neonatal Research Network (RFA-HD-23-002). We seek to continue to support the mission of the NRN to improve healthcare and outcomes for newborns, seeking solutions to increase survival without neurodevelopmental impairment or chronic illness for premature and critically ill newborn infants. We have several strengths that will advance the collaborative work of the NRN. 1. Our NICU is a world leader in the care of periviable infants, born at 22 and 23 weeks’ gestation. The survival rate of this population at the University of Iowa is the best in the United States, and the majority of these survivors are free of neurodevelopmental impairment. We bring expertise to inform research design as well as a relatively large periviable population available to participate in NRN studies. Our mortality for extremely low birth weight infants is perennially among the lowest in the NRN. 2. We have a strong tradition and culture of clinical research in infants. Our clinical research infrastructure in the NICU has a decades-long track record of successful participation in multicenter studies and contributions to important neonatal study findings. 3. Our NICU is the leading US center in the emerging neonatal subspecialty of neonatal hemodynamics. Our Hemodynamics group has developed the study methods and echocardiographic measurement standards for this modality and are global experts in its use both clinically and in physiologic and interventional research. That expertise can be harnessed in the NRN to pursue novel study designs. 4. As the only academic medical center in a largely rural state with an economy based in agriculture, we represent a population that is not otherwise well represented in the NICHD Network. Our partner site at Sanford Health in Sioux Falls, SD further enhances this diversity with the addition of a Native American population to our combined rural population. If the results of Network studies are to be generalized to patients throughout the country, this large area of the country should be represented. The University of Iowa Network center represents this region and population. 5. We have contributed significantly to the NRN’s work through the last 7 years. We have been among the highest enrolling sites in several studies despite our relatively low population, and we have had excellent follow-up rates for infants both in trials and in the Follow-up observational study.