Objective <p>This study aimed to determine the effect of ocean sounds played during ROP examinations on pain, comfort, and physiological parameters of premature infants.</p> Study design <p>In the randomized controlled trial, 44 premature infants were included in the study via stratified randomization. In the intervention group, ocean sounds were played starting 1 min before and until 5 min after the ROP examination. No sound was played for the control group. The examinations were recorded on video and evaluated by independent observers who were blinded to the study.</p> Results <p>There was no statistically significant difference in the pain levels and mean comfort scores between the two groups at 1 and 5 min after the procedure. Stabilization was achieved in both groups in heart rate and oxygen saturation; however, the difference between the groups was not significant.</p> Conclusions <p>Ocean sounds alone had no significant effect on pain, comfort or physiological parameters during ROP examinations.</p> Clinical Trial Registration <p>The protocol for this randomized controlled experimental trial is registered on ClinicalTrials.gov. The clinical trial registration number is <a href="https://clinicaltrials.gov">https://clinicaltrials.gov</a>; NCT05203159.</p>