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The study focused on assessing changes in echocardiographic and clinical parameters following its administration. This is a randomized controlled trial that included 80 full-term newborns diagnosed with PPHN within 72\u00a0h after birth. Participants were randomized into two groups: the NNG group received nebulized nitroglycerin, while the control group did not receive it as adjunctive therapy to PPHN. Clinical parameters and echocardiographic measures were evaluated before intervention, and subsequently at 24 and 48\u00a0h. The primary outcome was the estimated systolic pulmonary artery pressure in both groups. Comparative analyses were conducted between the groups, along with repeated measures within each group. The NNG group exhibited a significant improvement in the oxygenation index and oxygen saturation index (OI&amp;OSI) on days 2 and 3. There was a marked reduction in the systolic pulmonary artery pressure\/systolic systemic pressure (SPAP\/SSP) ratio, accompanied by a significant enhancement in biventricular systolic function and cardiac output. The myocardial performance index (MPI), as measured by tissue-Doppler echocardiography, was notably decreased in the NNG group on day 3. Furthermore, the requirements for ventilatory support and inotropic agents were significantly lower in the NNG group. Survival analysis indicated a more favorable weaning course in the NNG group.<\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusion<\/jats:italic>\n                    :\u00a0NNG was effective in managing neonates with PPHN and might be a promising, alternative therapy for PPHN, especially in settings where inhaled nitric oxide is unavailable.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Trial registration<\/jats:italic>\n                    : Clinical-Trial.gov identifier: NCT05741229 and was registered on February 14, 2023. 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Approval No. is 0201737 (17th November 2022) in IRB No. is 00012098 and FWA No. is 00018699. Written informed consents were obtained from parents or authorized legal representatives of all newborns who participated in the study for having treatment and echocardiographic scans at different times and publication of anonymous patients\u2019 data.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Informed consent was obtained from parents or authorized legal representatives of all newborns who participated in the study for publication of anonymous patients\u2019 data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"586"}}