European Journal of Pediatrics

, Volume 178, Issue 9, pp 1317–1324 | Cite as

Topical application of coconut oil to the skin of preterm infants: a systematic review

  • Sameer Shivaji PupalaEmail author
  • Shripada Rao
  • Tobias Strunk
  • Sanjay Patole
Original Article


Preterm infants are at risk of increased trans-epidermal water loss and infections due to epidermal immaturity. The emollient and anti-infective properties of coconut oil make it a potentially beneficial topical agent for this population. We aimed to systematically review randomised trials assessing the effects of topical coconut oil in preterm infants. Medline, EMBASE, Cochrane Central Register of Controlled Trials and CINAHL were searched. Seven trials (n = 727 infants) were included. The majority of trials included relatively mature infants (gestation > 32 weeks, birth weight > 1200 g). The duration of intervention (5–31 days) and outcomes of interest varied among included studies. Meta-analysis using random effects model found significantly lower incidence of hospital-acquired blood stream infections (HABSI) in the coconut oil group (11/164 vs 32/166; relative risk 0.35, 95% confidence interval 0.18, 0.67, p = 0.001; I2 = 0%, two RCTs). Overall, infants in the coconut oil group had decreased water loss, decreased infection rates, better growth and skin condition. There were no significant adverse effects associated with coconut oil application. The overall quality of evidence was considered moderate for the outcome of HABSI and low for the outcome of physical growth based on GRADE guidelines.

Conclusion: Topical coconut oil application to the skin may be beneficial in preterm infants, but the quality of evidence is low to moderate. Adequately powered randomised controlled trials, especially in very preterm (< 32 weeks) and extremely preterm (< 28 weeks) infants, are needed.

What is Known:

Coconut oil has been used traditionally for topical application in terms of infants in Asian countries

What is New:

This systematic review found that topical application of coconut oil may reduce the risk of infection and improve weight gain and skin condition in preterm infants. However, the quality of evidence was considered to be moderate to low based on GRADE guidelines.


Coconut oil Topical Preterm infant Sepsis Trans-epidermal water loss Skin 



Confidence interval


Hazard ratio


Inter quartile range


Late-onset sepsis


Preferred Reporting Items for Systematic Reviews and Meta-Analyses


Randomised controlled trial


Standard deviation


Trans-epidermal water loss


Authors’ contributions

Sameer Pupala: Concept, design, independent literature search selection of studies for inclusion, extraction and interpretation of the data, assessing the risk of bias of included studies, GRADE evidence, writing the first and final drafts of the manuscript; Shripada Rao: Independent literature search, selection of studies for inclusion, data extraction, meta-analysis to generate forest plots, GRADE evidence, helping with the first and final draft of the manuscript; Tobias Strunk: Concept, design, interpretation of the data, GRADE evidence, critical review of the first and the final draft of the manuscript. Sanjay Patole: Concept, design, interpretation of the data, GRADE evidence, critical review of the first and the final draft of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Not applicable since it was a systematic review.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sameer Shivaji Pupala
    • 1
    • 2
    Email author
  • Shripada Rao
    • 1
    • 2
  • Tobias Strunk
    • 1
    • 2
  • Sanjay Patole
    • 1
    • 2
  1. 1.Neonatal DirectorateKing Edward Memorial Hospital for Women and Perth Children’s HospitalPerthAustralia
  2. 2.Centre for Neonatal Research and Education, School of MedicineUniversity of Western AustraliaPerthAustralia

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