en Nursing Original Article <div style="text-align: justify;"><span style="font-size:12px;"><span style="font-family:Times New Roman;"><b>Background:</b> Preterm neonates are frequently exposed to painful procedures in neonatal intensive care units (NICUs), including endotracheal suctioning. Non-pharmacological interventions such as white noise may help reduce pain and improve physiological stability. This study aimed to investigate the effect of white noise on pain intensity and physiological parameters in preterm neonates during airway suctioning.<br> <b>Methods:</b> This parallel-group randomized controlled clinical trial was conducted on 50 preterm neonates admitted to the NICU of Afzalipour Hospital, Kerman, Iran. Eligible neonates were randomly assigned to intervention and control groups using a random number table. Allocation concealment was ensured using sequentially numbered, opaque, sealed envelopes prepared by an independent researcher. Neonates in the intervention group were exposed to white noise at 45 dB from 5 minutes before until 10 minutes after suctioning, whereas those in the control group received routine care. Pain was assessed using the Neonatal Infant Pain Scale (NIPS). Physiological parameters, including heart rate, oxygen saturation, respiratory rate, and body temperature, were recorded before, during, and after suctioning. Body temperature was measured using the skin temperature probe integrated into the neonatal vital signs monitor. Data were analyzed using SPSS v23. Repeated-measures analysis of variance with Greenhouse&ndash;Geisser correction was used to evaluate changes over time between groups. Independent t-test, Chi-square test, and Fisher&rsquo;s exact test were applied where appropriate. A P-value <0.05 was considered statistically significant.<br> <b>Results:</b> The intervention group showed significantly lower pain scores (P=0.001), heart rate (P<0.001), and respiratory rate (P=0.010) during suctioning compared with the control group. Oxygen saturation levels were significantly higher in the intervention group during the procedure (P<0.001). No significant differences were observed in body temperature between groups (P=1.000).<br> <b>Conclusion</b>: White noise reduced pain scores and improved heart rate, respiratory rate, and oxygen saturation during airway suctioning in preterm neonates. These findings support the use of white noise as a complementary non-pharmacological intervention in NICU care.</span></span></div> Infant, Premature, Pain, Suction, Neonatal intensive care unit (Intensive Care Units, Neonatal), White Noise 0 0 http://nmj.goums.ac.ir/browse.php?a_code=A-10-1519-4&slc_lang=en&sid=1 Reihane Moghimian Shahrbabaki moghimianreihane1@gmail.com 100319475328460018191 100319475328460018191 No Reproductive and Family Health Research Center, Kerman University of Medical Sciences, Kerman, Iran Zohreh Khoshnood khoshnood.tmu@gmail.com 100319475328460018192 100319475328460018192 No Department of Community Health Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran Saide Arya saeide.aria71@gmail.com 100319475328460018193 0009-0000-0154-1042 No Department of Pediatric and Neonatal Intensive Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran Najmeh Soltaninejad nsoltani5959@gmail.com 100319475328460018194 100319475328460018194 No Department of Pediatrics, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran Monirsadat Nematollahi monirnematollahi@yahoo.com 100319475328460018195 100319475328460018195 Yes Reproductive and Family Health Research Center, Kerman University of Medical Sciences, Kerman, Iran