[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Maternal and child nursing](https://durgical.com/en/nursing/areas/maternal-child/) › Caring for the preterm and low-birth-weight newborn: developmental care, feeding, skin and pain

# 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 Nov 13, 2026

## Key points

- Kangaroo position as early as possible, lengthened until continuous; WHO advises starting it right after birth without a first period in an incubator.
- Start feeding with the mother's own milk, preferably colostrum: it lowers the risk of necrotising enterocolitis. Donor milk is the next choice.
- Developmental care: containment in the incubator and control of light and noise.
- Before painful procedures: kangaroo position, containment, breastfeeding, non-nutritive sucking or oral sucrose per protocol.
- No bottle with a teat before breastfeeding is established; use a cup or syringe if needed.

## 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)

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

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/caring-for-the-preterm-and-low-birth-weight-newborn-developmental-care-feeding-s/)

## Connections

## Related 4

- [Kangaroo mother care](https://durgical.com/en/nursing/kangaroo-mother-care/)
- [Keeping the newborn warm: the warm chain, incubators and radiant warmers, hypothermia and overheating](https://durgical.com/en/nursing/keeping-the-newborn-warm-the-warm-chain-incubators-and-radiant-warmers-hypotherm/)
- [Enteral feeding: checking the tube, feeding and care](https://durgical.com/en/nursing/enteral-feeding-checking-the-tube-feeding-and-care/)
- [Pain assessment scales: numeric, visual analogue, faces, behavioural (FLACC) and in dementia](https://durgical.com/en/nursing/pain-assessment-scales-numeric-visual-analogue-faces-behavioural-and-in-dementia/)

## Related conditions 3

- [Necrotising enterocolitis](https://durgical.com/en/conditions/necrotising-enterocolitis/)
- [Retinopathy of prematurity](https://durgical.com/en/conditions/retinopathy-of-prematurity/)
- [Intraventricular haemorrhage of prematurity](https://durgical.com/en/conditions/intraventricular-haemorrhage-of-prematurity/)

[← All of nursing](https://durgical.com/en/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)](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/INEC/IETS/GPC_Completa_Premat.pdf) (Ministerio de Salud y Protección Social de Colombia, Colciencias, 2013); [WHO advises immediate skin to skin care for survival of small and preterm babies](https://www.who.int/news/item/15-11-2022-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)](https://perinatal.bvsalud.org/wp-content/uploads/2023/08/CLAP1577.pdf) (Organización Panamericana de la Salud, CLAP/SMR, 2011).

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Source: https://durgical.com/en/nursing/caring-for-the-preterm-and-low-birth-weight-newborn-developmental-care-feeding-s/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/caring-for-the-preterm-and-low-birth-weight-newborn-developmental-care-feeding-s/