"It is," says philosopher Nance Cunningham Butler, "a weird thing."

To the parents of thousands of premature infants, it is much, much more than just weird.

To Butler, a free-lance philosopher and ethicist who has spent the last several years campaigning against what she has seen as the medical community's disregard of infants as human beings, cruelty in the name of lifesaving is still cruel -- and incomprehensible.

To the parents of the smallest, the sickest, the weakest babies, it comes as the ultimate horror to discover that the struggle to save their tiny lives means weeks and months of virtually unrelieved pain -- from surgery and various procedures performed without anesthesia. The procedures to help them breathe, nourish them and monitor their blood, if performed on an older baby or adult, could only be done with something to block the pain.

The technology to save the lives of these babies exploded with such rapidity over the last decade that knowledge about how and what an infant could feel was outdistanced, actually lost amid the dials and the shunts and the tubes and the wires.

For these last few years, anesthetists (who are not MDs) and anesthesiologists (who are) have been confident in the accuracy of 40-year-old studies purporting to find the pain pathways in these babies "too immature" to transmit pain impulses, the brain centers "too undeveloped" to register them and the infant too unknowing to remember them anyway.

Pediatric surgeons often "did not know what was happening to the babies in their care, even in their own institutions," says Dr. Gerard W. Ostheimer, director of obstetric anesthesia at Brigham and Women's Hospital in Boston and associate professor of anesthesia at Harvard Medical School. Often, these surgeons thought they were operating on anesthesized infants, but in fact the infants had merely been immobilized with a paralytic drug.

As parents of newborns requiring surgery or intensive care began to learn this fact, and as many pediatric nurses and some pediatricians began to regard their small charges with more discerning observation, the climate began to change, as did the scientific evidence. For nearly the past two years, Ostheimer has been serving as liaison between the American Society of Anesthesiologists and the American Academy of Pediatrics as the two groups began to wrestle with the problem, a problem they barely knew existed only a few years earlier.

The result has been that now many opinion leaders in the medical community are conceding that parents and pediatric nurses who had been leading a public campaign against pain in the nursery had valid cause. Policy statements by powerful professional organizations -- the American Academy of Pediatrics and the American Society of Anesthesiologists -- will go far to convince practicing physicians that anesthesia is safe and effective -- and necessary. Any risk that anesthesia poses to infants can be overcome, and the benefits of pain-free and stress-free care are evident.

This change in thinking has been remarkably speedy for groups traditionally cautious about adopting new findings.

The American Academy of Pediatrics published a statement in its September journal that "local or systemic pharmacologic agents now available permit relatively safe administration of anesthesia or analgesia to neonates undergoing surgical procedures . . ."

Wrote the specialists, "There is an increasing body of evidence that neonates, including those born preterm, demonstrate physiologic responses to surgical procedures that are similar to those demonstrated by adults and that these responses can be lessened with anesthetic agents."

In short, the pediatricians and pediatric surgeons wrote, babies, even premature babies, hurt when they are operated upon, and the hurt can be safely and effectively blocked.

The American Society of Anesthesiologists, in an editorial in its September journal, went further, concluding that modern knowledge "usually allows even the sickest, smallest premature infant to be anesthetized safely." ::

Dr. Kanwaljeet Singh Anand, a research associate in anesthesiology at Harvard Medical School, was studying stress responses in newborn surgical patients at Oxford University in England. Why, he and his colleagues wondered, was the response of stress hormones in some of these newborns up to five times that of adults?

"What we stumbled onto at that point was the fact that they were getting very little anesthesia. They were just getting small amounts of nitrous oxide and muscle relaxants." Furthermore Anand found -- this was in about 1982, he recalls -- that "if for any reason whatsoever, even if it was not related to the anesthetic management, if the oxygen saturation in the infant's blood was to fall, the tendency was to switch off nitrous oxide and leave oxygen, thereby leaving a totally conscious baby, paralyzed on the operating table."

This use of a paralytic with intermittent whiffs of nitrous oxide, Anand learned, was a world-famous technique predicated on the theory that babies did not feel pain. Because it was developed at a children's hospital in Liverpool it became known as the "Liverpool technique" and he says, "is still being practiced in Liverpool despite evidence to the contrary. Habits die hard, particularly in the places where they originated."

Much of the "evidence to the contrary" comes from studies Anand then originated, which were published only this year in the journal Lancet and scheduled to be published in a forthcoming British Medical Journal. The work demonstrated that babies undergoing surgery for repair of a common arterial abnormality in premature infants -- patent ductus arteriosus -- had less stress, fewer complications and a better recovery when they were fully anesthetized than did the infants given a curare derivative, which "relaxes" or paralyzes the infants. The paralyzed infants "had circulatory and metabolic complications postoperatively," whereas the anesthetized babies did not.

The unpublished study, also completed while Anand was in England, examined an even more potent anesthetic. Says Anand, "I won't hide the fact that I was surprised to note the differences in the clinical status of these babies during the first 24 hours post operatively. We found the babies who did not get the {deep anesthetic} had more complications," such as irregular heartbeats, gastric bleeding and the need for more oxygen.

Anand is continuing studies, currently with a group of infants undergoing open heart surgery. Here, too, preliminary results are supporting his hypothesis that a good clinical outcome depends on reduced stress during surgery, which in turn depends on adequate anesthesia. ::

But the professional statements alone do not satisfy either ethicist Butler, pediatric anesthesiologist Ostheimer or Anand. "The hooker," says the plainspoken Ostheimer, "is that now that we've dealt with the true surgical decisions, what are we going to do about things like circumcision? And about putting chest tubes in kids with collapsed lungs? This opens a whole new ballgame and everybody says,'I hope it goes away.' But I can tell you, it won't."

Anand believes that until there is a worldwide series of trials -- sponsored by a prestigious institution such as the National Institutes of Health -- the problem will continue. "Right now," he says, "we know there is not much pain relief for premature infants."