after you agree to join the study, basic information such as weight and gestational age is recorded.

you are assigned to receive either intranasal dexmedetomidine or a placebo (0.3 ml sodium chloride solution) without knowing which one.

the care team prepares three eye‑drop solutions that are part of standard care:

oxibuprokain eye drops (1.2 mg per dose),

phenylephrine eye drops (150 µg per dose), and

cyclopentolate eye drops (150 µg per dose).

each drop is applied to the infant’s eyes according to the protocol before the screening exam.

once the eye drops are in place, the assigned study medication is given intranasally.

if you are in the active group, the dose is dexmedetomidine 2 µg per kilogram of body weight delivered as a nasal spray.

if you are in the placebo group, you receive 0.3 ml of sodium chloride solution intranasally.

the medication is given once for each screening session.

the ophthalmologist performs the retinopathy of prematurity screening using a speculum.

pain is assessed during the first 30 seconds after the speculum is inserted using the premature infant pain profile‑revised (pipp‑r) score.

additional observations such as heart rate, respiratory rate, oxygen saturation, and any cardiorespiratory events are recorded.

after the speculum is removed, pain is assessed again with the pipp‑r score.

the infant is observed for at least one hour to monitor heart rate, breathing, oxygen needs, cry duration, sleep time, vomiting episodes, and any changes in respiratory support.

all observations are entered into the study database.