2026, Number 2
Effect of topical application of medium chain triglycerides (MCT) on weight gain in preterm newborns in a neonatal unit, comparative study
Full text
10.35366/122609
Language: English/Spanish [Versión en español]
References: 14
Page: 93-97
PDF size: 251.73 Kb.
ABSTRACT
Weight Gain (WG) is a critical component in the development of any premature infant; integrating neonatal care measures that promote weight gain is essential. It has been observed that the topical application of oils has positive effects on weight gain. Our objective was to determine the impact that the application of MCT has on the weight of premature newborns; a descriptive and comparative analysis was carried out between the weight of premature newborns between 28-34 weeks of gestation at birth, to whom MCT was applied topically and those who did not receive it; patients hospitalized for at least 14 days in the neonatal intensive care unit were included, who were not seriously ill, without skin malformations and whose medical record included all the necessary information. Data were collected from 65 patients, of which 40% received MCT topically; the median gestational age was 31.4 WG vs 32.4 WG in the group that did not receive MCT, this difference being significant. We found that there were no statistically significant differences between the groups in relation to weight gain; both groups decreased their weight percentile (p < 0.001), although there was no statistically significant difference between the groups.ABBREVIATIONS:
- GA = gestational age
- MCT = medium-chain triglycerides
- NICU = neonatal intensive care unit
INTRODUCTION
Weight gain is a critical component in the development of any premature baby; integrating neonatal care measures that reduce weight loss and promote weight gain during this period is essential to ensure optimal growth and development.1-3
In neonatal intensive care units (NICU), general measures have been integrated to optimize weight gain and reduce weight loss, such as the early initiation of enteral nutrition and the application of topical emollients. Studies suggest that massage with emollients increases the supply of essential fatty acids, resulting in decreased mortality and improved growth in premature newborns.4-6
The topical application of medium-chain triglycerides (MCT) is used in our unit; therefore, we considered comparing the difference in weight between preterm newborns treated with topical MCT against those who do not receive them. Currently, the mechanisms involved in weight gain through MCT application are not clear. One proposed mechanism is transcutaneous feeding, which may result in accelerated weight gain in this group. MCTs are fatty acid esters frequently used in premature neonates because they are a rapid and easily available energy source; they represent nearly 17% of lipids in the breast milk of premature babies and up to 25% of milk formulas for preterm neonates; their use has expanded because, compared to long-chain triglycerides, they are better absorbed, hydrolyzed, and oxidized, making them a better energy source while reducing energy expenditure, which is thought to impact weight gain.1,3,7,13
Sankaranarayanan and colleagues demonstrated that the topical application of emollients results in improved skin barrier function, temperature regulation, and a decrease in insensible water loss by blocking sweat gland pores. Positive effects on growth and a reduction in caloric expenditure from cold stress have been evidenced. Shyam and Kumar suggest that MCT therapy in low-income countries can be a cost-effective method to favor weight gain in low-birth-weight infants. It is important to mention that, so far, most studies are based on the application of vegetable oils such as coconut and sunflower, with very few involving the application of MCT specifically.1,3,8,9
The objective of our study was to compare the weight gain of premature newborns to whom MCT was topically applied in relation to the weight gain of premature newborns without the topical application of MCT.
MATERIAL AND METHODS
An analytical, longitudinal, retrospective cohort study was conducted over five years, which was approved by the hospital's ethics committee. Clinical record data were included from premature newborns between 28 and 34 weeks of gestation (GA) who were hospitalized for at least 14 days in the NICU; for the MCT patient group, all those who received topical triglycerides at least once a day from admission and maintained the treatment for a minimum of 14 days were included. Patients with congenital anomalies, skin diseases, severe illness, and those whose outcome was death were excluded from the study. All cases whose clinical records did not contain complete information were eliminated.
It was evaluated whether the application of topical MCT had an impact on weight gain, making a comparison between the weight of newborns who received MCT and those who did not, at seven and 14 days of life; similarly, it was evaluated whether there was a change in the percentile track of the patients after the intervention, and this was compared with changes in the percentile track of those who did not receive it at seven and 14 days.
RESULTS
Data were collected from 65 patients, of whom 53.8% were females. The mean gestational age of the global series was 32.3 GA. The mean birth weight was 1,730 grams, with a mean birth weight percentile of 43.3 and a mean percentile after treatment of 19.1.
Of the total number of patients, 40% received topical MCT; the median gestational age was 32 vs 32.4 GA in the group that did not receive MCT, with no significant difference. The average birth weight of those who received transcutaneous MCT was 1,603 g, with a mean birth weight percentile of 37.3; patients who did not receive MCT had a mean birth weight of 1,815 g, with an average percentile of 47.3; it is worth noting that neither birth weight nor its corresponding percentile was statistically significant.
When comparing the treatment groups, we found that birth weight was higher in the group that did not receive MCT; similarly, this group was on average four days older than those who did receive MCT; there is no statistically significant difference between the weight percentiles of both groups (Table 1).
Regarding the response to the application or non-application of MCT on the weight or weight percentile of the patients after two weeks of intervention, we found no statistically significant differences (Table 2).
At seven days, both groups lost weight, being higher in patients who did receive topical MCT (average loss of 2.8%) compared to those who did not receive the intervention (average loss of 1.3%); it should be noted that in both cases, the weight lost was lower than expected during the first week of life, which can amount to up to 15% in premature newborns. During the second week (days 8-14), both groups showed weight gain; the percutaneous MCT group presented a gain of 14.3 g/kg/day, closer to the expected target for newborns weighing less than 2 kg (weight gain of 15-20 g/kg/day) compared to the cases that did not have the intervention, who gained 12.5 g/kg/day (Table 3) (Figure 1).
A comparison was made between the difference in weight in premature infants under and over 30 GA to whom MCT was applied, finding no greater benefit after the intervention in those who were more premature.
DISCUSSION
Newborns, and especially premature infants, are vulnerable individuals; characteristics such as low weight, poor weight gain, increased transepidermal water loss, and skin immaturity make them more prone to infections and an increased incidence of neonatal death. Adequate weight gain (15-20 g/kg/day) is associated with a decrease in hospital stay days and readmissions, as well as lower morbidity and mortality.2,3,5,10
In the NICU, actions have been implemented both to increase weight gain and to reduce dermal lesions, including lubricating patients with emollients. Massaging newborns with emollients is an intervention used as a traditional practice in many countries to provide a physical barrier to the skin, reduce microbial invasion, minimize transepidermal water loss, and conserve heat and energy for growth, which consequently improves weight gain in premature newborns.4-6,11
Massages have been reported to promote weight gain in premature neonates. Massage therapy can be beneficial as a feeding method in premature infants who exhibit feeding difficulties and uncoordinated sucking-swallowing, due to being a rapid and easily available energy source.1,3,12,13
One of the measures used in our hospital to decrease weight loss and improve weight gain in premature babies is based on the application of medium-chain triglycerides over the entire body, at least once a day, directly onto the skin; 60% of our patients did not have MCT applications as part of their interventions, while the remaining 40% did receive them as part of their comprehensive treatment.
Our study showed that weight gain was not statistically significant in those babies to whom MCT was applied, which differs from information obtained in other studies, such as the one conducted by Reza Saeidi3 and colleagues, where patients to whom MCT was applied through skin massage had significantly greater weight gain than those to whom emollients were not applied. It is important to note that in our hospital, the application of MCT is not accompanied by a massage as part of the routine, which may have modified the result regarding the weight difference between our two groups. It is suggested that massages generate pressure stimulation that affects vagal activity, releasing hormones that affect and improve gastric absorption and motility, and increase the release and effect of insulin; doubts remain as to whether it is the massage per se, the application of oils, or the combination of both that improves weight gain.1,3
In the study by Garbi and colleagues, it is mentioned that the average weight gain among patients in whom oil and massage were applied vs. those who only received massage or only received oil showed no significant differences, which agrees with the results obtained during our observation. Similarly, Fallah and colleagues in 2013 studied weight gain in cases where oil was applied and those where it was not, obtaining non-significant results regarding the difference in weight gain between both groups.13,14
CONCLUSIONS
Considering the results obtained in this study, the use of topical MCT did not have a statistically significant impact on weight gain compared to those who did not receive the intervention. However, if we only consider the average weight gain target mentioned in world literature, we observe that cases using percutaneous MCT do reach the weight target at the end of the intervention, compared to those to whom it is not applied. The literature contemplates the possibility of associating MCT application with a massage, which has been shown to have a greater effect on weight gain compared to those who only receive emollients; this opens up the possibility to expand observation and design new strategies to optimize the use of emollients. A major limitation we encountered was our very limited sample size to conduct the study; it would be ideal to expand it in future studies.
REFERENCES
Kukreja B, Kumar A, Satyanarayana L. Effect on nosocomial sepsis of topical oil application, skin condition, and care practice device usage in preterm neonates: a randomized controlled trial. Indian J Child Health. 2018; 5 (11): 689-693. Available from: https://mansapublishers.com/ijch/article/view/1265
Garbi A, Armand M, Beltrán-Anzola AA, Sarté C, Brévaut-Malaty V, Tosello B et al. Effect of massage with oil balanced in essential fatty acids on development and lipid parameters in very premature neonates: a randomized, controlled study. Children (Basel). 2022; 9 (4): 463. doi: 10.3390/children9040463.
AFFILIATIONS
1 Grupo Angeles Health System. Ciudad de México, México.
2 Departamento de Neonatología.
3 Departamento de investigación. Facultad Mexicana de Medicina de la Universidad La Salle.
4 Profesor adjunto de Neonatología. Facultad Mexicana de Medicina de la Universidad La Salle.
ORCID:
5 0009-0007-1357-7107
6 0000-0003-3790-2043
7 0000-0002-2888-1781
8 0000-0003-1559-7332
9 0000-0002-1537-1475
10 0000-0002-1167-1446
If you wish to consult the supplementary data for this article, please contact editorial.actamedica@saludangeles.mx
CORRESPONDENCE
Jacquelinne Itzel Elizalde Aranda. Correo electrónico: itze.jea@gmail.comReceived: 2024-11-01. Accepted: 2025-03-13.