In this preliminary study, it was examined whether capacity to react to external stress (acute pain) during neonatal intensive care predicts later neuromotor development at 4 and 8 months corrected chronological age (CCA) in high-risk preterm infants. Behavioural and cardiac reactivity to blood collection at 32 weeks postconceptional age (PCA) were recorded in addition to developmental outcomes at 4 and 8 months CCA in 35 preterm infants (17 males, 18 females) born <or=800 g and/or <or=25 weeks gestational age (GA). Pain reactivity during routine heel lance for blood collection at 32 weeks GA was measured using a composite score derived from the Neonatal Facial Coding System, change in infant sleep/wake state, and spectral analysis of heart rate. Motor development was assessed using the Movement Assessment of Infants scale and the Bayley Scales of Infant Development. Low biobehavioural pain reactivity at 32 weeks PCA was associated with poorer overall quality of motor function at 8 months CCA, but not at 4 months CCA. It was concluded that pain reactivity before discharge from the neonatal intensive care unit may be a useful marker of neuromotor development in infancy.