INTRODUCTION: Topical emollients have been shown to reduce transepidermal water loss (TEWL). Such an effect of coconut oil (often used in traditional massage of infants in India) has not been studied.

OBJECTIVE: Our goal was to determine the efficacy of topical coconut-oil application in reducing TEWL in preterm very low birth weight (VLBW) neonates.

METHODS: Seventy-four preterm VLBW infants were randomly assigned at 12 hours of age to either 4 mL of topical coconut-oil application every 12 hours for 7 days (n = 37) or no oil application (n = 37). TEWL was measured at 12 hours of age and thereafter every 12 hours for 7 days in both groups by using a Vapometer (Delfin Technologies, Kuopio, Finland), a portable closed-chamber evaporimeter. The ambient and skin-surface relative humidity and temperature were recorded simultaneously.

RESULTS: Birth weight (1213 ± 214 vs 1164 ± 208 g), gestation (32 ± 2 vs 31 ± 2 weeks), and other baseline variables were comparable between the 2 groups. TEWL was significantly lower in the infants in the coconut-oil group at each point of measurement. Although TEWL declined for those in both groups during the first week of life, proportional reduction in TEWL in the infants in the coconut-oil group was much greater compared with controls. Significantly lower TEWL in the infants in the coconut-oil group persisted after adjusting for differences in baseline variables by using a generalized estimating equation population-averaged model (an advanced form of regression analysis) (mean difference: 6.8 g/m2 per hour all during first week of life [95% confidence interval: 3.5–10.2]; P = .000).

CONCLUSIONS: Coconut-oil application in preterm VLBW neonates reduced TEWL by as much as 46%. Such an impact is expected to be of clinical importance, because it could reduce initial weight loss, promote better growth, and reduce fluid requirements.

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