This is a 25-week gestational age infant, now at day 7 of life, who has remained on non-invasive respiratory support following an initial period of mechanical ventilation. Over the past 24 hours, there has been increasing concern about respiratory instability, with fluctuating oxygen requirements and intermittent tachycardia. The infant’s blood pressure has been borderline low (30/13 with M22). Oxygen needs have gradually increased, with a FiO2 now at 40-50% on nasal CPAP with pressures of 8 cmH2O. Despite targeted respiratory support adjustments, there has been difficulty in weaning off oxygen. The chest X-ray shows increased pulmonary congestion with hazy lung fields, while the abdominal X-ray is unremarkable with normal bowel gas distribution. The infant has decreased activity, showing decreased spontaneous movements compared to previous days. A cranial ultrasound has ruled out significant intraventricular hemorrhage (IVH). Additionally, there is concern regarding urine output, which has been on the lower end at 0.8-1.0 mL/kg/hr over the past 12 hours. Given these concerns, a targeted neonatal echocardiography (TNE) was requested to rule out any hemodynamically significant cardiac contributors to the infant’s evolving clinical status. Weight: 650 grams