Utilization pattern of oral sildenafil and changes in clinical parameters among neonates with persistent pulmonary hypertension: A retrospective study in an Indonesian hospital

Persistent pulmonary hypertension of the newborn (PPHN) is a serious neonatal condition characterized by failure of normal pulmonary vascular adaptation after birth, resulting in persistent hypoxemia. In resource-limited settings, limited access to inhaled nitric oxide and extracorporeal membrane oxygenation may increase the use of more accessible pulmonary vasodilators such as oral sildenafil. This study aimed to describe the utilization pattern of oral sildenafil and assess changes in heart rate, respiratory rate, and peripheral oxygen saturation (SpO 2 ) among neonates with PPHN. A retrospective observational study was conducted using electronic medical records of neonates with PPHN who received oral sildenafil between January 2024 and October 2025. Complete cases with documented baseline and final heart rate, respiratory rate, and SpO₂ were included in the paired analysis. Sildenafil dose, dosing frequency, and treatment duration were also evaluated. Changes in clinical parameters were analyzed using paired statistical tests according to the data distribution. A total of 54 neonates were included. Most were term neonates (87.0%) and had a birth weight ≥2,500 g (96.3%). Sildenafil was most commonly administered at a dose of >0.5 mg/kg/dose (63.0%) four times daily (96.3%). Respiratory rate decreased from a mean of 53.44 to 49.63 breaths/minute, with a statistically significant difference ( p = 0.008). Heart rate remained stable, changing from 137.28 to 136.87 beats/minute ( p = 0.896). SpO₂ increased numerically from 96.37% to 97.26%, but the difference was not statistically significant ( p = 0.067). Among neonates with PPHN and complete follow-up documentation, respiratory rate decreased significantly during hospitalization, while heart rate remained stable and SpO₂ showed a nonsignificant numerical increase. However, these observed changes cannot be attributed solely to sildenafil because of the retrospective design, absence of a comparator group, potential selection bias from complete-case analysis, and concurrent supportive therapies. Prospective controlled studies with standardized clinical and echocardiographic assessments are warranted to clarify the role of oral sildenafil in neonatal PPHN management.