Background: Persistent pulmonary hypertension of the newborn (PPHN) remains a significant cause of neonatal morbidity and mortality, particularly in resource limited settings. Understanding the clinical profile and maternal risk factors is crucial for early identification and prevention strategies in rural healthcare environments. Objective: To evaluate the clinical characteristics, maternal risk factors, and demographic profile of neonates with PPHN in a rural tertiary care hospital setting. Methods: A descriptive longitudinal study was conducted over two years (June 2022 to June 2024) at Dr. Balasaheb Vikhe Patil Rural Medical College, Maharashtra, India. Eighty neonates with echocardiographically confirmed PPHN were enrolled. Data on maternal risk factors, gestational age, birth weight, mode of delivery, and clinical presentation were systematically collected and analyzed using SPSS 24.0. Results: Of 80 neonates with PPHN, 65% were male and 56.3% were term babies. The majority (72.5%) were inborn deliveries. Meconium-stained amniotic fluid (MSAF) was the most significant maternal risk factor (42.5%), followed by premature rupture of membranes (18.8%) and gestational diabetes mellitus (7.5%). Appropriate for gestational age (AGA) neonates comprised 73.8% of cases, with mean birth weight of 2625.44±598.15 grams. Most neonates (47.5%) were delivered by lower segment cesarean section. Severe respiratory distress was present in 32.5% of cases, with 87.5% developing PPHN after 24 hours of life. MSAF showed significant association with moderate to severe PPHN cases (p=0.05). Conclusions: PPHN predominantly affects term, AGA male neonates in our rural setting. MSAF emerges as the primary modifiable maternal risk factor, emphasizing the importance of improved antepartum and intrapartum obstetric care. Early identification of high-risk pregnancies and prompt management of meconium stained deliveries could significantly reduce PPHN incidence. These findings have important implications for developing prevention strategies in resource-limited rural healthcare settings.