A large district general hospital has called to request a transfer of a 4 kg, 6-month-old ex 25-week premature infant, who is an inpatient in their level 3 NICU. The baby has not left hospital since birth and had a difficult neonatal course. He was intubated at birth and was not successfully extubated until 10 weeks of life. He has significant bronchopulmonary dysplasia (BPD) as a result of his extreme prematurity with secondary pulmonary hypertension diagnosed on echocardiogram. Although he has been relatively stable on high flow nasal cannula oxygen (HFNC) 8 L/min of flow and FiO2 0.4, he has deteriorated today. His usual medications are sildenafil for pulmonary hypertension; furosemide and spironolactone for chronic lung disease; and weaning doses of clonidine and chloral hydrate for agitation.