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Caring for the preterm and low-birth-weight newborn: developmental care, feeding, skin and pain

  • Safe practice

Preterm babies need warmth, their mother's milk, kangaroo contact, calm surroundings, pain relief for procedures and their family beside them.

Updated

What it is

Preterm birth is now the leading cause of death in children under 5; about 15 million babies are born preterm each year. Even late-preterm babies have more feeding problems, hypoglycaemia, jaundice, unstable temperature and apnoea than term babies. Nursing care protects the baby's growth and brain: warmth, kangaroo contact, feeding with the mother's own milk, gentle handling in a calm unit, prevention and relief of procedural pain, strict infection control and a family that takes part in care. Colombia's preterm guideline and WHO's 2022 recommendations set these practices.

What it requires

  • Preterm: born before 37 weeks. Late preterm: 34 weeks 0 days to 36 weeks 6 days.
  • Colombian guideline: kangaroo position started within the first 10 days and kept until the baby controls its temperature.
  • Non-nutritive sucking at the breast before 34 weeks helps sucking mature and the mother's milk supply.
  • Retinopathy screening for every baby born before 33 weeks, and for those of 33 to 36 weeks with other risk factors.
  • Parents' visits are not restricted to set hours.

Components

  • Thermal care (see newborn thermoregulation).
  • Kangaroo mother care.
  • Feeding with the mother's own milk, expressed early and often.
  • Containment, low light and low noise.
  • Non-drug pain relief and pain assessment.
  • Infection prevention and an open unit for the family.

How it is applied (and why)

  1. Keep the baby warm from birth with the measures for its gestational age — cold is especially harmful to preterm babies.
  2. Start kangaroo contact as soon as the baby is stable and lengthen it to continuous — it helps temperature, breathing, feeding and bonding.
  3. Help the mother express milk early and often, and give colostrum first — mother's milk lowers the risk of necrotising enterocolitis.
  4. In tube-fed babies, offer non-nutritive sucking at the breast and move straight to breastfeeding — it shortens the hospital stay.
  5. Do not give a bottle with a teat before breastfeeding is established; use a cup or syringe — protects breastfeeding.
  6. Use containment in the incubator and keep light and noise low — calm surroundings support brain development.
  7. Before heel pricks and other painful procedures, use kangaroo, containment, breastfeeding or sucking, and assess pain with the unit's scale.
  8. Group cares, handle gently and keep strict hand hygiene — every handling and invasive procedure carries stress and infection risk.
  9. Involve the parents in daily care and teach them the warning signs — the family is the baby's main caregiver after discharge.
  10. Check that retinopathy screening, hearing screening and discharge criteria are met before discharge.

In nursing practice

  • Watch for apnoea, feeding intolerance or a swollen abdomen, unstable temperature, low glucose and jaundice.
  • Do not wash blood off a preterm baby's skin at birth: it increases heat loss.
  • Routine suctioning of the mouth and nose can cause apnoea and a slow heart rate; suction only when the airway is blocked.
  • Keep saturation in the prescribed target range: both low and high oxygen levels harm preterm babies.
  • Colombian guideline: the baby can go home in kangaroo position when it is stable, feeds by mouth, gains weight and the family is trained and has follow-up.

Common mistakes

  • Giving a bottle with a teat before breastfeeding is established.
  • Restricting the parents' visits to fixed hours.
  • Doing heel pricks without non-drug pain relief.
  • Bright light, loud alarms and noise around the incubator.
  • Suctioning or handling the baby by routine instead of by need.

Test yourself

Think of the answer, then tap the question to see it.

Why should a preterm baby's first feeds be its own mother's milk, preferably colostrum?

Because it lowers the risk of necrotising enterocolitis.

What did WHO recommend in 2022 about starting kangaroo care for small and preterm babies?

Starting skin-to-skin contact right after birth, without a first period in an incubator.

Which non-drug measures relieve pain during a heel prick in a preterm baby?

Kangaroo position, containment, breastfeeding, non-nutritive sucking or oral sucrose per protocol.

Which three components of developmental care does the Colombian preterm guideline keep?

Containment in the incubator, control of light and noise, and kangaroo mother care.

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Connections

← All of nursing

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Guía de práctica clínica del recién nacido prematuro (Guía No. 04) (Ministerio de Salud y Protección Social de Colombia, Colciencias, 2013); WHO advises immediate skin to skin care for survival of small and preterm babies (World Health Organization, 2022); Salud sexual y reproductiva: guías para el continuo de atención de la mujer y el recién nacido focalizadas en APS, 3.ª ed. (CLAP/SMR 1577) (Organización Panamericana de la Salud, CLAP/SMR, 2011).

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Representative model, for educational purposes only.