n additional problem. The lack of verbal reporting encountered with the fetus and neonate requires another form of measure which is reliable and accurate. Some markers used as signs of pain and stress in studies on neonates have been crying, negative facial expressions, limb withdrawals and flexion reflexes. In the fetus these signs are not present so movement and hormonal levels have been used.
             Impressive advances in intensive care over the last decade means that babies born prematurely can now be kept alive from 22-24 weeks. Preterm infants are subjected to greater stress than full term infants. They will regularly suffer acute pain whilst in Neonatal Intensive Care Units due to increased invasive surgical procedures that will be carried out on them. According to Porter et al 1998 on average preterms will undergo between 3-15 invasive procedures a day, most of these being heelsticks. Interventions such as chest tubes, mechanical ventilation, tracheal suctioning and the more stressful, unfriendly environment in the NICU can place great stress on the fetus during an important stage of its development. During this crucial stage in development there is increased plasticity so therefore the effects of pain or stress can have a greater impact.
             Few intrauterine surgical procedures are carried out annually in the UK; therefore it is more beneficial to study preterm infants. They provide a useful foundation for research as they are considered very similar to third trimester fetuses. A number of follow up studies carried out on preterm babies have shown an increased prevalence of neurological, neurobehavioral and psychosocial disorders. These include decreased motor performance, visual and auditory defects and learning disorders amongst others Hack et al 1994, Pharaoh et al 1994, Marlow et al 1993 and Grunau et al 1994. However it is very difficult to ascertain how many of these problems can be directly linked to pain and stress or simply a...