The University of Tennessee was awarded a $915,604 Cooperative Agreement by the National Heart, Lung, and Blood Institute (NHLBI) under the Cardiovascular Diseases Research program (CFDA 93.837) to conduct a multi-center clinical trial on the use of inhaled nitric oxide (INO) in the treatment of congenital diaphragmatic hernia (CDH) in newborns. The primary objective is to determine if de-implementing the use of INO during the post-natal resuscitation and stabilization phase affects the composite outcome of extracorporeal life support (ECLS) use and/or mortality in CDH patients. The study will also assess the cost-effectiveness of this de-implementation approach and evaluate factors influencing INO de-implementation at the physician and site levels. This initiative aims to advance the adoption of cost-effective, evidence-based strategies in neonatal and pediatric care for CDH, a complex congenital condition affecting approximately 1,500 children annually in the U.S.