Abstract. Prematurely born infants are observed at a Neonatal Intensive Care Unit (NICU) for medical treatment. Whereas vital body functions are continuously monitored, their incubator is covered by a blanket for medical reasons. This prevents visual observation of the newborns during most time of the day, while it is known that the facial expression can give valuable information about the presence of discomfort. This prompted the authors to develop a prototype of an automated video survey system for the detection of discomfort in newborn babies by analysis of their facial expression. Since only a reliable and situationindependent system is useful, we focus at robustness against non-ideal viewpoints and lighting conditions. Our proposed algorithm automatically segments the face from the background and localizes the eye, eyebrow and mouth regions. Based upon measurements in these regions, a hierarchical classifier is employed to discriminate between the behavioral states sleep, awake a...