BACKGROUND: Nutritional status is crucial in neonatal survival, especially among the Very Low Birthweight (VLBW) preterm infants. They have low nutrient reserves with increased metabolic needs and immature gut system. Several studies have proven the efficacy of medium-chain triglycerides (MCT) as a good source of calories among pre-term infants. However, such is not commercially available. Virgin coconut oil (VCO) has the most concentrated content of MCT's, hence a possible source of MCT.

OBJECTIVES: This review aims to determine the efficacy of VCO-supplementation to milk feeding in augmenting weight gain among very low birth weight preterm infants.

METHODS: Pubmed (1975-September 2016), Cochrane Central Register of Controlled Trials (The Cochrane Library, September 2016), HERDIN (1966 -September 2016), Google Scholar (September 2016), and https://clinicaltrials.gov (last searched September 2016) were thoroughly searched. Manual search in reference and citation lists of the eligible studies and list of abstracts from the Philippine Pediatric Society was also reviewed. Only randomized controlled trials comparing VCO-supplemented milk versus standard care in weight gain among very low birth weight preterm infants were included. The author reviewed each study's quality and extracted data on weight gain. Weighted mean differences with 95% confidence intervals were reported. Risk of biases among studies were also evaluated.

RESULTS: Three randomized controlled trials involving 290 infants were included. All trials were of good quality with relatively low heterogeneity (39%), and low risk of biases. Overall, infants receiving VCO-supplemented milk feeding had statistically significant weight gain compared to those given non-fortified milk (mean difference 5.31, 95% CI: 3.83 to 11.93).

CONCLUSION: Virgin coconut oil is effective in augmenting weight gain among very low birth weight preterm infants.

RECOMMENDATIONS: Small trials were used in this review, and a single multicenter randomized controlled trial would be ideal to further establish these findings.