Transcutaneous Feeding: The Effect of Massage with Coconut Oil on Weight Gaining in Preterm Newborns

This Article


Creative Commons License
Except where otherwise noted, this work is licensed under Creative Commons Attribution-NonCommercial 4.0 International License.

Article Information:

Group: 2011
Subgroup: Volume 13, Issue 9, Sep
Date: September 2011
Type: Short Communication
Start Page: 666
End Page: 669


  • R Saeedi
  • Department of Neonatology, Qaem Hospital Mashhad University of Medical Sci-ences, Mashhad, Iran
  • M Gholami
  • Department of Midwifery, Islamic Azad University, Neyshabur Branch, Neyshabur, Iran
  • SH Dinparvar
  • Department of Nursing and Midwifery, Qaem Hospital, Mashhad University of Medical SciencesMashhad, Iran ,
  • M Kabirian
  • Department of Nursing and Midwifery, Qaem Hospital, Mashhad University of Medical SciencesMashhad, Iran,


      Affiliation: Department of Midwifery, Islamic Azad University, Neyshabur Branch
      City, Province: Neyshabur,
      Country: Iran
      Tel: +98-915-5245880


Background: Transcutaneous feeding is suggested for very low birth weight infants. This study evaluates the effect of massage with coconut oil on weight gaining in preterm newborns.


Methods: This quasi-experimental study was conducted from Aug 2007 to Mar 2008 in Mashhad University of Medical Sciences. Seventy three newborns were randomly assigned to three groups. Weight of newborns was measured daily during the study in three groups: A (massage with coconut oil), B (massage only), C (control group) by a nurse who was blind to the study.


Results: There was a significant difference between three groups in weight gaining after intervention. The results of Tukey test indicated that difference between groups A and B, A and C was significant but there was not a significant difference between group B and C.


Conclusion: Massage with coconut oil had a positive effect on weight gaining in preterm newborns.


Keywords: Massage;Coconut oil;Preterm newborn;Weight gain;Transcutaneous feeding

Manuscript Body:



Preterm delivery (1 Growth status and velocity are important markers of the health and wellbeing of the preterm newborns.2 It is recommended that composition of weight gain in the preterm infant approximates that of the fetus at the same postconceptional age.3 Perinatal hypoxia and poor sucking ability places the preterm infant at risk for malnutrition and weight loss.4

Nowadays, topical oil application is suggested to have a positive effect on growth. Massage with oil enhances the positive effects of massage on newborns.5 The practice of oil massage has gained favor in neonatal intensive care units in the developed countries as well.6

Coconut oil is composed entirely of medium-chain acids (MCFAs) which provides a source of highly efficient cellular food. When it is applied topically, the cells absorb the MCFAs and convert them into energy. Because MCFAs are used to produce energy rather than packed away into fat cells, coconut oil can be in weight gain.7 Solanki, et al. (2005) and Sankaranarayanan, et al. (2005) reported that topically applied coconut oil can be absorbed in neonates and is probably available for nutritional purposes and enhanced weight gain velocity in the preterm babies.8,9 Topical oil massage is traditionally practiced in many countries. However while the practice has been in place for decades, its scientific basis remains uncertain. Therefore, this study was undertaken to examine the effect of massage with coconut oil on weight gaining in preterm newborns.



Materials and Methods 


This quasi-experimental study was conducted from Aug 2007 to Mar 2008 to evaluate the effect of massage with coconut oil on weight gain in preterm newborns. The setting was NICU of a training hospital in Mashhad University of Medical Sciences. The study's sample size was estimated based on the consequences of a pilot study. The required sample for each group was 25 (total=75) to achieve 80% power at a 5 % level of significance.

Neonates enrolled in this study were at gestational age of less than 37 weeks, 2-10 days of life, medically stable with no requirement of drugs, ventilation or parentral nutrition and without congenital anomalies or skin diseases. Exclusion criteria included transport to other hospitals or discharge before the end of study's period, improvement from severe diseases and whose parents refused consent to continue follow-up. Eligible neonates were randomly assigned into 3 groups: Group A (Massage with coconut oil), Group B (Only massage) and Group C (Control). A computer generated randomized list was used to assign neonates.

In group A, massage with coconut oil was performed by a trained person on all available surfaces of the baby in prone and supine positions. Four ml of the coconut oil was massaged during 5 minutes, 4 times a day for 7 days. To avoid absorption of the oil by sheets, the neonates were placed on a plastic sheet for 20 minutes. In group B, babies were massaged during 5 minutes, 4 times a day for 7 days by the same person in group A, just without oil. In group C or control group, there was no intervention.

During the massage's period, infants were under controlled conditions of temperature and monitored for heart and respiratory rates and oxygen saturation. Weight of newborns was taken without clothes on an electronic weighting scale with an accuracy of 15 grams by an expert midwife who was blind to assign neonates. Data were analyzed using SPSS software (Version 14, Chicago, IL, USA). All demographic information was summarized by using descriptive statistics. The groups were compared for equivalency on demographic indicators, using one-way ANOVA. The differences in the mean of weight (between the first and the end of study's period) for the three groups were separately analyzed by the paired t-test. ANOVA and Tukey tests were used to determine whether there was any difference in gaining weight between groups. The significant level was set at p





Of the 75 neonates initially randomized, 2 were excluded from the study. One neonate was discharged and developed to severe jaundice before the end of study. Demographic and health data were present for the 73 preterm newborns in Table 1. There were 41 males (56.2%) and 32 females (43.8%) ranging in gestational age from 27 to 37 weeks. 40 babies were early preterm (GA≤32 weeks) and 33 were 32-37 weeks. Their birth weights ranged from 900 to 2800gr.


Table 1:Baseline Characteristics of the Three Study Groups.


Massage with coconut oil

(Group A)

Only massage

(Group B)


(Group C)





Male / Female




Birth weight (g)

Mean (SD)



1738.8 (495.2)



1779.5 (473.4)



1424.8 (325.3)


Gest.age (wks)

Mean (SD)


    32.8 (3.1)


    33 (2.3)


    31.3 (2.2)

Birth legth

Mean (SD)



    42.2 (4.1)



    42.7 (4.2)



    41.3 (3.3)


Birth head circumference

Mean (SD)



    29.5 (2.3)



    29.8 (2.7)



    29.1 (1.9)


weight gaining

Mean±SD (gr)




No significant difference was found in sex, birth weight, gestational age, birth leght and Birth head circumference (p<0.05)(Table1).



There was no significant differences (p<0.050) among the three groups with respect to sex, gestational age, length, head circumference and mean of Apgar score. But birth weight was significantly higher in Group B than in groups A and C (p=0.011). There was a significant difference in weight gaining (difference at 1 and 7 days of study) in the three groups (p<0.001, Figure 1). Difference between group A (Massage with coconut oil) and B (Only massage) and C (Control) was significant (p=0.002 and p= 0.005), but there was not a significant difference between groups B and C (p>0.050).



Fig. 1:Comparison of weight gaining in 7 days in three study group.





Massage with coconut oil is traditionally practiced in many countries but the adverse or benefit effects of topical oil massage in preterm neonates on their growth has remained unresolved.10 We know the preterm and very low birth weight infants have many problems in feeding and they can not tolerate full feeding at the first days of birth. The present study, therefore, attempts to evaluate the effect of massage with coconut oil on weight gaining in preterm newborns.

In our study, a higher weight gaining over 7 days was observed in the coconut oil massage group (212. 40±240.28 g) compared to only massage (7.39±96.68 g) and control groups (28±224.4 g). Also, the difference in weight gaining between the only massage group and the control was insignificant.

The results of the present study are similar to Arora et al. (2005) study indicating that gaining weight was significantly greater in the oil massage group (11.6±4.3 g/kg/day) as compared to only massage group (8.7±4.6 g/kg/day) and no massage group (8.3±4.9 g/kg/day).10

Dabi et al. (2000) also reported a significantly higher standardized weight gain in the oil massage group (19.18±4.38 g/kg/day) compared to the control group (14.25±3.92 g/kg/day).11 Sorano et al. (2000) in a trial of 60 preterm neonates reported significantly higher weight gain over a 30 days period in the oil massage group compared to those who received routine care (703±129 g vs 576±140 g; p<0.05).12

There are limitations in this clinical trial study that should be discussed. Results of this study cannot be generalized to full term, high risk and very low birth weight neonates. However separate analysis of infants with appropriate and retarded intra uterine growth could not be done because of inadequate sample size. Also it was better that, we could control study by a placebo group. Massage with coconut oil had a positive effect on weight gain in preterm newborns.




We are thankful from Mashhad University of Medical Sciences for support of this study.


Conflict of interest: None declared.

References: (12)

  1. Rudolph CD, Rudolph AM, Hostetter MK, Lister G, Siegel Pediatrics. 21th ed. McGraw-Hill Professional; 2003; p. 58.
  2. Casey PH. Growth of low birth weight preterm children. Semin Perinatol 2008;32:20-7. [18249236] []
  3. Thureen PJ, Hay WW. Neonatal Nutrition and Metabolism. Cambridge University Press, 2006; p. 51.
  4. Ricci SS. Essentials of Maternity, Newborn and s Health NursingWomen Lippincott Williams & Wilkins, 2006; p. 646.
  5. Holey EA, Cook EM. Evidence-based Therapeutic Massage: A Practical Guide for Therapists. 2th ed. Churchill Livingstone, 2003; p. 328.
  6. Darmstadt GL, Saha SK. Traditional practice of oil massage of neonates in Bangladesh. J Health Popul Nutr 2002;20:184-8. [12186200]
  7. Fife B. Coconut cures: Preventing and Treating Common Health Problems with coconut. Piccadilly Book (ltd), 2006; p. 33-44.
  8. Solanki K, Matnani M, Kale M, Joshi K, Bavdekar A, Bhave SH , Pandit B, Pandit A. Transcutaneous Absorption of Topically Massaged Oil in Neonates. Indian Pediatr 2005;42:998-1005. [16269830]
  9. Sankaranarayanan K, Mondkar JA, Chauhan MM, Mascarenhas BM, Mainkar AR, Salvi RY. Oil Massage in Neonates: An Open Randomized Controlled Study of Coconut versus Mineral Oil. Indian Pediatr 2005;42:877-84. [16208048]
  10. Arora J, Kumar A, Ramji S. Effect of Oil Massage on Growth and Neurobehavior in Very Low Birth Weight Preterm Neonates. Indian Pediatr 2005;42:1092-100. [16340050]
  11. Dabi DR, Arora V, Mohan P, Kothari U, Dashora T. XX th Annual Convention of National Neonatalogy Forum, Mumbai, 3-5 November, 2000.
  12. Soriano CR, Martinez FE, Jorge SM. Cutaneous application of vegetable oil as a coadjuvant in the nutritional management of preterm infants. J Pediatr Gastroenterol Nutr 2000;31:387-90. [11045835] []