Once consented, participants will be randomized to one of two groups by selection of an opaque folder by the study investigator. A PAS will be assigned at 1 hour after only having received traditional standard of care therapies and before placing the subject on the therapy determined by the randomization. If the child receives a score of 7 or less, he/she will not be placed on NIPPV; however, they will be analyzed in this group based on intention to treat.