The losses of piglets in commercial pig farming remain at concerning levels and need to be addressed through the implementation of new sustainable breeding and management strategies. In fact, piglets are especially at risk in the first days of life. Both genetics and the farrowing process have been shown to impact piglet vitality. In addition, knowledge of the animal-intrinsic responses in adapting to extra-uterine life is particularly important but is scarcely described in the scientific literature. In this review, the three phases that constitute neonatal adaptation in the pig are systematically presented. The first phase of early adaptation involves primarily the development of cardiorespiratory function (within the first 10 min of life) as well as thermoregulatory processes and acid–base balance (up to 24 h of life). In the second phase, homeostasis is established, and organ maturation takes place (up to 14 d post natum). The final third phase aims at the development of neurological, immunological and muscular features (up to 28 d of life). The involvement of aggravating and ameliorating factors such as dystocia, low colostrum yield and heat supply is key to the development of strategies to reduce piglet losses and increase vitality. The insights are of particular value in addressing current concerns in pig farming and to further improve animal welfare in pig production across different management types.