PROJECT SUMMARY Retinopathy of prematurity (ROP) is a neurovascular disorder that occurs mainly among extremely preterm infants. The National Eye Institute (NEI) estimates that every year between 400 and 600 children become legally blind due to ROP. The goal of this project is to plan a large, multicenter cohort study designed to gather comprehensive social, clinical, and biomarker data needed to further elucidate the etiology and pathogenesis of ROP and adverse visual outcomes (AVO) in extremely low gestational age newborns (ELGANs, <28weeks gestation). The aims of the project are (1) to finalize the consortium and create expert working groups (WGs) that will tackle the planning tasks in their area of expertise, (2) to develop the study protocol and Manual of Procedures (MOP), and (3) to outline and perform preliminary and feasibility studies. The planned study will have multiple innovative elements, the most important being (a) first multicenter observational study with a focus on ROP/AVO, (b) retina imaging at multiple timepoints after birth, (c) artificial intelligence/machine learning approaches, (d) social determinants of health, (e) pre- and postnatal biomarker measurements, and (f) visual and neurodevelopmental outcome assessment.