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Background Persistent pulmonary hypertension of newborns (PPHN) is an acute neonatal disorder with a high mortality rate despite several advances in its management.Design This was a prospective cross-sectional study.Setting 84 asphyxiated neonates were included. All the participants underwent complete transthoracic echocardiography to assess the parameters for the diagnosis of PPHN.Patient Newborns with PPHN diagnosed via echocardiography with perinatal asphyxia who were admitted to the newborn unit.Interventions Echocardiography was performed within 72 hours of life. The mean age at echocardiography was 38.4±0.71 hours.Main outcome measures The severity of asphyxia, gestational age and place of birth (inborn), delivery at the study centre or ‘out-born’ and delivery at another facility or location away from the study centre were significantly associated with the development of PPHN.Results The prevalence of PPHN in the study was 52.4%. The severity of asphyxia, gestational age and place of birth (inborn), delivery at the study centre or ‘out-born’ and delivery at another facility or location away from the study centre were significantly associated with the development of PPHN (p<0.05). Severe asphyxia was approximately nine times more likely to be associated with the development of PPHN than mild asphyxia (AOR=9.89; 95% CI 1.92 to 50.94, p=0.006) and was the single most significant predictor of PPHN in the present study. However, the severity of asphyxia was not associated with the severity of PPHN.Conclusion and relevance Severe asphyxia was the single most significant predictor of the development of PPHN among asphyxiated neonates. The prevalence of PPHN among asphyxiated neonates was high. A high index of suspicion and the routine use of echocardiography and sildenafil to diagnose and treat PPHN in asphyxiated neonates are recommended.