This study investigating the association between sildenafil treatment and worsening ROP found that although infants treated with sildenafil had a higher prevalence of severe ROP than those without sildenafil, they did not have a significantly higher rate of worsening ROP.The difference in ROP rate between sildenafil-exposed and -unexposed infants remains a concern, and larger studies may be needed to evaluate this association more thoroughly. As expected, the infants with BPD and pulmonary hypertension treated with sildenafil had longer duration of respiratory support and a higher rate of late-onset sepsis, suggesting a more severe clinical course.