In Canada, many babies are born early, at less than full term of pregnancy (40 weeks). Some of them, about 900 a year including 80-95 here in BC, are born very, very early (<26 weeks) and have a high chance of dying or having serious brain injury. These babies are cared for in a neonatal intensive care unit (NICU), where critical medical decisions are often based on research that has not included newborns who are as small and fragile like them and rarely asks families what actually matters to them. Our BOOST (Better Outcomes for the Sickest & Tiniest) program will do studies called clinical trials to find better ways to help these babies. We will test treatments that vary widely across Canadian NICUs (for example, use of a medicine called indomethacin given intravenously immediately after birth). These treatments may lower the risk of two things parents say are important: severe bleeding in the baby’s brain and death. Our research will put the new evidence in the context of values and preferences of families of diverse backgrounds and I will work with national groups in Canada to update the current evidence and develop medical guidelines that improves care of these tiny babies.