Hyper-prolific sows frequently do not have a sufficient number of functional teats for their piglets to nurse which has led to the use of nurse sows to manage these surplus piglets. This review discusses strategies for using nurse sows and factors that influence preweaning survival and weight gain of their litters, as well as those that affect their subsequent rebreeding performance. Rearing piglets using a nurse sow can be as successful as piglets reared with their biological mother and is thus a powerful management tool to decrease preweaning piglet mortality. Selecting a young sow as nurse sow is beneficial for piglet survival; however, piglets nursing first parity sows often have a lower daily weight gain than piglets nursing multiparous sows. A litter of uniform surplus piglets is preferably handled using the two-step nurse sow strategy. A consequence of nonuniform litters will most likely be an increased mortality and decreased weaning weight among the smallest piglets within a litter. The subsequent fertility of nurse sows is not compromised. There is an increased risk of lactational oestrus when using nurse sows leading to an increased weaning-to-oestrus interval; however, litter size in nurse sows is identical or even moderately higher in the subsequent parity compared with nonnurse sows.
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