Effect Of Medium-Chain Triglyceride Oil Massage On Postnatal Weight Gain In Term And Late Preterm Neonates: A Randomized Controlled Trial

Dr. Vinay V. Kulkarni, et al. Effect Of Medium-Chain Triglyceride Oil Massage On Postnatal Weight Gain In Term And Late Preterm Neonates: A Randomized Controlled Trial. Int. J Med. Pharm. Res., 6 (5): 936‐947, 2025 936 International Journal of Medical and Pharmaceutical Research Online ISSN-2958-3683 | Print ISSN-2958-3675 Frequency: Bi-Monthly Available online on: https://ijmpr.in/ Research Article Effect Of Medium-Chain Triglyceride Oil Massage On Postnatal Weight Gain In Term And Late Preterm Neonates: A Randomized Controlled Trial Dr. Vinay V. Kulkarni1*, Dr. Mohammed Mateen2, Dr. Indira Bai N3, Dr. Ayesha Jabeen2 1Department of Neonatology, Nice Hospital for Women and Children, Hyderabad, Telangana, India. 2Department of Pediatrics, Muslim Maternity and Children’s Hospital, Hyderabad, Telangana, India. 3Department of Neonatology, Ankura Hospital for Women and Children - LB Nagar, Hyderabad, Telangana, India A B S T R A C T Corresponding Author: Dr. Vinay V. Kulkarni MD, DM, Department of Neonatology, Nice Hospital for Women and Children, Hyderabad, Telangana, India. Received: 21-08-2025 Accepted: 22-09-2025 Available online: 30-09-2025 Background: Topical oil massage is a traditional neonatal care practice. While both coconut oil and medium-chain triglyceride (MCT) oil have shown individual benefits, no prior randomized controlled trial has compared their efficacy in Indian neonates. Objective: To evaluate the comparative effects of MCT oil versus coconut oil massage on postnatal weight gain in term and late preterm neonates over eight weeks in Indian settings. Methods: A double-blind randomized controlled trial was conducted among term and late preterm neonates at a single center. Participants were randomized to receive daily massages with either MCT oil or coconut oil for eight weeks. The primary outcome was weight gain from baseline to week 8. Results: A total of 200 neonates (term and late preterm) were randomized to receive daily body massage using either MCT oil (n=105) or coconut oil (n=95). Both groups showed progressive weight gain; however, the MCT group showed significantly greater mean weight gain from week 3 onwards. At week 6, the MCT group had a mean weight of 4.82 kg vs. 4.58 kg in the coconut oil group (p<0.001; Cohen’s d=0.81). Adjusted weight gain from week 2 to week 8 was also significantly higher in the MCT group (1.39 kg vs. 1.26 kg, p=0.006). Subgroup analysis showed that late preterm neonates in the MCT group also experienced significantly greater weight gain, with the largest effect observed at week 6 (Cohen’s d=0.82). No serious adverse events were reported. Compliance exceeded 90% in both groups. Conclusion: MCT oil massage significantly enhances weight gain in neonates and may be considered a safe, effective, and culturally acceptable strategy in newborn care protocols. Copyright © International Journal of Medical and Pharmaceutical Research Keywords: Infant massage, MCT oil, Neonatal growth, Neonatal nutrition, Postnatal weight gain, Preterm infant. INTRODUCTION Low birth weight (LBW), defined as a birth weight less than 2500 grams, remains a major public health concern in India and South Asia, where it affects an estimated 26.4% of newborns and significantly increases the risk of neonatal mortality and long-term morbidity.1 In particular, term and late preterm neonates with suboptimal birth weight face a higher risk of poor thermoregulation, infections, neurodevelopmental delays, and extended hospitalization.2,3 Promoting adequate postnatal weight gain during the neonatal period is therefore essential for improving shortand long-term health outcomes.1,2 Topical oil massage is a culturally rooted, cost-effective, and widely practiced neonatal care intervention across South Asia, traditionally believed to promote warmth, strengthen bones, and support growth.4,5 Emerging clinical evidence supports these beliefs, with studies demonstrating that neonatal massage improves weight gain, enhances skin barrier function, reduces transepidermal water loss, and stimulates vagal activity, thereby aiding digestion and overall development.6,7 Neonatal skin, especially in preterm infants, is structurally immature, more permeable, thinner, and Dr. Vinay V. Kulkarni, et al. Effect Of Medium-Chain Triglyceride Oil Massage On Postnatal Weight Gain In Term And Late Preterm Neonates: A Randomized Controlled Trial. Int. J Med. Pharm. Res., 6 (5): 936‐947, 2025 937 lacking complete lipid barriers. Biocompatible oils may also offer occlusive protection and serve as nutritional adjuncts via transcutaneous absorption of essential fatty acids.3,8 A meta-analysis of 15 trials involving 697 infants found that moderate-pressure massage increased daily weight gain by approximately 5 grams compared to controls.4 Indian studies have also reported that massage using natural oils improves growth metrics compared to mineral oil or no treatment 5,9 Coconut oil is the most commonly used massage oil in Indian households due to its local availability, cultural acceptance, and beneficial properties. It is rich in lauric acid and has demonstrated moisturizing, antimicrobial, and thermoregulatory effects.6,10 Experimental studies suggest that fatty acids from coconut oil can be absorbed through the immature neonatal skin, potentially contributing to caloric intake.10 These properties make coconut oil a favorable choice for traditional neonatal massage.6 Medium-chain triglyceride (MCT) oil, composed primarily of caprylic (C8) and capric (C10) acids, has also gained attention for its potential in neonatal nutrition. MCTs are more readily absorbed than long -chain fats and do not require bile salts or pancreatic enzymes, making them especially suitable for infants with immature digestive systems.11 MCT oil is already used in specialized neonatal feeds due to its superior fat and nitrogen absorption profile.11 In a randomized trial, preterm infants massaged with MCT oil demonstrated significantly greater weight gain within the first week compared to those who received no oil massage.12 While both coconut and MCT oils have individually demonstrated benefits for neonatal growth, no study has directly compared their efficacy when used for topical massage in Indian newborns. Given the differences in lipid composition and dermal absorption characteristics, such a comparison is important to inform evidence -based recommendations for neonatal care in home settings.3,5,13 This randomized controlled trial was designed to address this gap by comparing the efficacy of MCT oil versus coconut oil massage in promoting postnatal weight gain among term and late preterm neonates in India over the first eight weeks of life. We hypothesized that MCT oil, due to its superior dermal absorption and caloric efficiency, would result in greater weight gain than coconut oil. In addition, the study assessed the safety, tolerability, acceptability, and potential secondary effects of both oils on skin health, feeding, and sleep behaviors. METHODS Study design and setting This was a prospective, double-blind, randomized controlled trial conducted at the Muslim Maternity and Children’s Hospital, located in Chaderghat, Hyderabad, India. The trial was conducted over a 12 -month period from January 1, 2024, to December 31, 2024. Ethical considerations The study was approved by the Institutional Ethics Committee of Muslim Maternity and Children’s Hospital, Hyderabad and was was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki (2013 revision), Indian Council of Medical Research (ICMR) National Ethical Guidelines (2017), and the guidelines of Good Clinical Practice (GCP). The study was registered with the Clinical Trials Registry of India (CTRI; registration number: 2024/06/086780) prior to participant recruitment. The trial was reported in accordance with the CONSORT guidelines for randomized controlled trials. Written informed consent was obtained from all parents or legal guardians of participating neonates before enrollment. All data were anonymized and stored securely, with access restricted to the research team to ensure confidentiality and privacy. Study Participants A total of 200 neonates were enrolled and stratified equally into two gestational age categories: term neonates (born between 37⁰/₇ and 41⁶/₇ weeks of gestation) and late preterm neonates (born between 34⁰/₇ and 36⁶/₇ weeks). Within each stratum, neonates were randomized in a 1:1 ratio to receive either MCT oil massage or coconut oil massage. Inclusion criteria comprised neonates born between 34⁰/₇ and 41⁶/₇ weeks of gestational age with appropriate birth weight for gestational age (AGA), who were hemodynamically stable within the first 48 hours of life, and for whom written parental consent was obtained. Neonates were excluded if they had major congenital malformations, required intensive care for more than 48 hours post-birth, exhibited cutaneous infections or dermatitis, or had a known hypersensitivity to oil-based products. Sample Size Calculation The sample size was calculated based on the primary outcome measure of mean weight gain (in grams) over eight weeks. Drawing from pilot data and published literature in similar neonatal populations, the expected mean weight gain in the coconut oil group was estimated at 3000 grams, with a standard deviation of 600 grams. A mean difference of 250 grams was considered clinically significant. Assuming a two-sided significance level of 5% (α = 0.05) and 80% power (β = 0.20), the sample size required per group was 91 neonates. The calculation was based on the formula for comparing two independent means: n = ((Zₐ/₂ + Zᵦ) / (Δ / σ))² × 2 Where Zα/2=1.96 for 95% confidence, Zβ=0.84 for 80% power, Δ=250 grams (expected difference), and σ=600 grams (standard deviation). Dr. Vinay V. Kulkarni, et al. Effect Of Medium-Chain Triglyceride Oil Massage On Postnatal Weight Gain In Term And Late Preterm Neonates: A Randomized Controlled Trial. Int. J Med. Pharm. Res., 6 (5): 936‐947, 2025 938 After adjusting for an anticipated attrition rate of 10%, the final sample size was increased to 100 neonates per group, leading to a total sample size of 200 neonates. Stratified randomization ensured equal representation of term and late preterm neonates across both intervention arms. Randomization and Blinding Eligible neonates were randomized using a stratified block randomization technique. Stratification was based on gestational age, with separate blocks for term and late preterm neonates. A computer-generated randomization sequence, prepared by an independent statistician, was used to assign participants in blocks of varying sizes (4, 6, and 8) to either the MCT oil or coconut oil massage group. Allocation concealment was ensured through the use of opaque, sealed envelopes, color-coded by gestational category (red for term, yellow for late preterm), which were opened sequentially upon enrollment. The MCT oil used in the study was ‘NiQu CT Oil’ manufactured by NeoWinn Biotech (caprylic acid to capric acid ratio of 70:30, while the coconut oil used was from Dr. Gold. Both oils were bulk -filled directly from their original containers following strict hygienic protocols to ensure quality and safety. Blinding was rigorously maintained at multiple levels. Caregivers administering the massage, outcome assessors recording the neonates’ weights, and the statistical analysts were all blinded to group assignment. Both MCT oil and coconut oil were dispensed in identical, opaque, white bottles labeled only with randomization codes. The physical properties of the two oils, including viscosity, color, and scent, were closely matched to prevent perceptual bias. Preparation and labeling of the intervention bottles were performed solely by the corresponding investigator, who maintained the master randomization list in a password-protected file inaccessible to other study personnel until data analysis. Intervention Protocol Neonates began receiving the intervention within the first 48 hours of life. The assigned oil (10 mL per session) was applied via gentle massage once daily for eight weeks. Massage was performed by trained caregivers for a minimum duration of 10 to 15 minutes and covered the entire body except the face and scalp. Adherence to the massage protocol was recorded in printed logbooks maintained by the caregivers. Outcomes Measures Baseline data were recorded for all neonates at the time of enrollment. This included demographic and clinical information such as sex, gestational age, birth weight, type of feeding initiated, categorized as direct breastfeeding (DBF)/mixed feeding/or formula feeding. In addition, size for gestational age was also recorded, which was classified as small for gestational age (SGA)/ appropriate for gestational age (AGA)/or large for gestational age (LGA). The primary outcome of the study was the mean weight gain (in grams) from baseline (birth) to the end of eight weeks. Secondary outcomes included the incidence of local adverse skin reactions such as erythema, rash, or skin breakdown; caregiverreported acceptability and compliance with the massage regimen (assessed at weeks 4 and 8); and qualitative maternal reports on neonatal feeding behavior and sleep patterns collected during weekly follow-up visits. Statistical analysis All data were entered into Microsoft Excel and subsequently analyzed using IBM SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables, such as weight and weight gain, were summarized using means and standard deviations (SD) or medians with interquartile ranges (IQR) where appropriate, based on normality testing using the Shapiro-Wilk test. Categorical variables, including sex, type of feeding, and adverse skin reactions, were expressed as frequencies and percentages. For the primary outcome, mean weight gain over eight weeks, comparisons between the MCT oil and coconut oil groups were performed using the independent samples t-test for normally distributed data or the Mann-Whitney U test for nonnormally distributed data. Weekly weight differences were also compared at each time point using similar methods. Repeated measures were analyzed using mixed-effects models with group, time, and group × time interaction as fixed effects, and individual neonate as a random effect, to account for intra -subject correlation over time. Subgroup analyses were pre-specified for term vs. late preterm neonates, and similar statistical tests were applied within each subgroup to evaluate differential effects of the intervention. Categorical variables were compared using the Chisquare test or Fisher’s exact test as appropriate. All analyses were conducted on an intention -to-treat basis. A two-tailed p-value of <0.05 was considered statistically significant. RESULTS Participant Flow and Baseline Characteristics A total of 200 neonates were enrolled and randomized into two groups to receive MCT oil massage (n=105) or coconut oil massage (n=95). The participants were equally stratified by gestational age, with 101 (50.5%) categorized as late preterm and 99 (49.5%) as term neonates. The distribution between intervention arms was balanced within each stratum, Dr. Vinay V. Kulkarni, et al. Effect Of Medium-Chain Triglyceride Oil Massage On Postnatal Weight Gain In Term And Late Preterm Neonates: A Randomized Controlled Trial. Int. J Med. Pharm. Res., 6 (5): 936‐947, 2025 939 with 51 late preterm and 54 term neonates in the MCT group, and 50 late preterm and 45 term neonates in the coconut oil group. Figure 1 shows the flow of participants in the study. Figure 1: Flow diagram Baseline demographic and clinical characteristics of the enrolled neonates were comparable between the MCT oil and coconut oil groups, demonstrating effective randomization. No statistically significant differences were observed between groups in terms of gestational age (Figure 2) (p = 0.273), sex distribution (p = 0.804), feeding pattern at enrollment (p = 0.313), classification by size for gestational age (SGA, AGA, or LGA) (p = 0.832), or birth weight (p = 0.220). All p - values exceeded the standard 0.05 threshold for statistical significance (all p>0.05), and the corresponding effect sizes, Cohen’s d for continuous variables and Cramér’s V for categorical comparisons, were uniformly small or negligible (Table 1). Table 1: Baseline demography and clinical characteristics of neonates by intervention groups Variable MCT Group (n = 105) Coconut oil Group (n = 95) Test Type pvalue Effect Size Gestational Age (weeks) 37.37 ± 2.02 37.07 ± 1.93 Independent ttest 0.273 d = 0.16 (very small)* Sex (Male %) 56 (53.3%) 49 (51.6%) Chi-square test 0.804 Cramér’s V=0.02 (negligible) Feeding Pattern DBF 12 16 Chi-square test (3x2) 0.313 Cramér’s V=0.11 (small) Formula 26 28 Mixed 67 51 Size for gestational age SGA 2 3 Chi-square test (3x2) 0.832 Cramér’s V=0.04 (negligible) AGA 85 77 LGA 18 15 Birth Weight (kg) 2.85 ± 0.37 2.78 ± 0.40 Independent ttest 0.22 d = 0.17 (very small)* Dr. Vinay V. Kulkarni, et al. Effect Of Medium-Chain Triglyceride Oil Massage On Postnatal Weight Gain In Term And Late Preterm Neonates: A Randomized Controlled Trial. Int. J Med. Pharm. Res., 6 (5): 936‐947, 2025 940 Figure 2. Distribution of Gestational Age in Both Groups Box plot comparing gestational age (in weeks) among neonates enrolled in the MCT oil and coconut oil massage groups. The figure depicts the median, interquartile range, and outliers, demonstrating a comparable distribution of gestational age between the two groups with majority of infants in the late preterm and term range. AGA: Appropriate for gestational age; DBF: Direct breastfeeding; LGA: Large for gestational age; MCT: Medium-chain triglyceride; SGA: Small for gestational age. *For both gestational age and birth weight, Levene’s test p > 0.05, indicating equal variances, validating the use of t-tests with pooled variance. Primary Outcome Week-wise absolute weight gain Both groups showed steady and progressive increases in weight over the 8-week follow-up period; however, neonates in the MCT oil group consistently exhibited greater mean weights from week 3 onwards (Table 2). By Week 4, the mean weight in the MCT group was significantly higher than that of the coconut oil group (p = 0.022), and the difference continued to become prominent through subsequent weeks in favor of the MCT group. The most pronounced difference was observed at Week 6, where the MCT group had a significantly higher mean weight compared to the coconut oil group (p < 0.001). (Figures 3 and 4) Table 2: Weekly Body Weight Comparison Between MCT and Coconut Oil Groups Week Absolute Weekly Weights Cumulative Weekly Weight Gain MCT Group (Kg) Coconut Oil Group (Kg) p-value* MCT Group (Kg) Coconut Oil Group (Kg) pvalue# Cohen’s d (Effect Size) Week 1 2.82 ± 0.37 2.76 ± 0.41 0.220 -0.01 ± 0.09 -0.02 ± 0.08 0.619 0.07 Week 2 3.03 ± 0.39 2.94 ± 0.42 0.228 0.19 ± 0.12 0.17 ± 0.10 0.088 0.24 Week 3 3.25 ± 0.40 3.12 ± 0.43 0.050 0.41 ± 0.15 0.35 ± 0.12 0.001 0.47 Week 4 3.48 ± 0.41 3.32 ± 0.44 0.022 0.64 ± 0.18 0.54 ± 0.14 <0.001 0.60 Week 5 3.70 ± 0.42 3.51 ± 0.44 0.001 0.86 ± 0.20 0.73 ± 0.16 <0.001 0.72 Week 6 3.92 ± 0.43 3.70 ± 0.46 <0.001 1.09 ± 0.21 0.92 ± 0.18 <0.001 0.81 Week 7 4.17 ± 0.50 3.93 ± 0.53 0.013 1.33 ± 0.30 1.15 ± 0.28 <0.001 0.61 Week 8 4.44 ± 0.51 4.15 ± 0.54 0.006 1.58 ± 0.31 1.37 ± 0.30 <0.001 0.71 Data presented as Mean ± SD. *Between-Group comparison with p-values derived from independent samples t-tests at each week. #p-values are from two-tailed t-tests assuming equal variances. *#A p-value of less than 0.05 was considered statistically significant. MCT: Medium-chain triglyceride. Dr. Vinay V. Kulkarni, et al. Effect Of Medium-Chain Triglyceride Oil Massage On Postnatal Weight Gain In Term And Late Preterm Neonates: A Randomized Controlled Trial. Int. J Med. Pharm. Res., 6 (5): 936‐947, 2025 941 Figure 3. Weekly Serial Weight Distribution Box plot illustrating the serial weights (in grams) of neonates from Week 1 to Week 8 in both MCT oil and coconut oil massage groups. Each weekly box shows the median weight, interquartile range, and range of values. This figure reflectsthe overall weight progression in both groups and highlights greater intergroup separation in later weeks. Figure 4. Mean Serial Weight Gain Trends in Two Groups Line graph representing the trend of mean weekly weight gain (delta weight) over 8 weeks of follow-up. The x-axis denotes postnatal weeks (Week 1 to Week 8), and the y-axis represents mean weight gain in grams. The MCT oil group shows consistently higher weight gain, with a statistically significant difference observed particularly at Week 6 (p = 0.003), suggesting a potentially enhanced anabolic effect of MCT oil during this phase. -0.01 0.19 0.41 0.64 0.86 1.09 1.33 1.58 -0.02 0.17 0.35 0.54 0.73 0.92 1.15 1.37 -0.2 -0.1 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 2 1 2 3 4 5 6 7 8 WEIGHT GAIN KG POSTNATAL AGE IN WEEKS---> SERIAL WEIGHT GAINS IN 2 GROUPS MCT Mean Coconut Mean Dr. Vinay V. Kulkarni, et al. Effect Of Medium-Chain Triglyceride Oil Massage On Postnatal Weight Gain In Term And Late Preterm Neonates: A Randomized Controlled Trial. Int. J Med. Pharm. Res., 6 (5): 936‐947, 2025 942 A two-way repeated measures ANOVA confirmed a statistically significant main effect of time (p < 0.001), group (p = 0.005), and a strong interaction effect between time and group (p< 0.001), indicating that the trajectory of weight gain differed meaningfully between groups, with the MCT group showing accelerated and sustained growth. A statistically significant increase in weight gain was observed in the MCT group from Week 3 through Week 8 (Table 2). The effect size of the intervention progressively increased over time, reaching its peak at Week 6 with a large effect size (Cohen’s d = 0.81). In contrast, weight gain differences between groups during the initial two weeks were minimal and not statistically significant, indicating that the effects of the intervention became more pronounced over time. Adjusted Weight Gain To correct for physiological postnatal weight fluctuations, weight at week 2 was considered as the baseline for calculating adjusted weight-gains. From Week 2 onward, neonates in the MCT oil group consistently exhibited significantly greater weight gain compared to those in the coconut oil group (Table 3). At Week 4, the difference was statistically significant (p < 0.001), with a medium effect size (Cohen’s d = 0.76). This difference became more pronounced by Week 6, where a large effect size was observed (d = 0.92). The trend persisted at Week 8, with the MCT group maintaining a statistically significant advantage (p = 0.006) and a small but meaningful effect size (d = 0.39). Table 3: Post-Week-2 Weight Gain (kg) Between Groups at Weeks 4, 6, and 8 Week Group Weight gain (kg) t (df) pvalue* 95% CI Cohen’s d Effect Size Week 4 MCT 0.45 ± 0.11 -5.36 (188.5) <0.001 [-0.10, -0.04] 0.76 Medium Coconut oil 0.38 ± 0.08 Week 6 MCT 0.89 ± 0.15 -6.48 (197) <0.001 [-0.17, -0.09] 0.92 Large Coconut oil 0.76 ± 0.14 Week 8 MCT 1.46 ± 0.60 -2.77 (198) 0.006 [-0.38, -0.06] 0.39 Small Coconut oil 1.23 ± 0.53 Data presented as Mean ± SD. *A p-value of less than 0.05 was considered statistically significant. MCT: Medium-chain triglyceride. Percentage Weight Gain Percentage Weight Gain from Birth No significant difference in percentage weight change was observed between groups at week 1 and Week 2, consistent with the expected physiological weight loss and stabilization phase in neonates. From Week 3 onward, the MCT group demonstrated consistently greater percentage weight gain compared to the coconut oil group, with statistically significant differences at each time point (Table 4). This trend closely mirrored the pattern observed for absolute weight gain. Effect sizes increased progressively over time, starting as small as weeks 3 and 4, and reaching medium magnitude at Weeks 5 and 6, suggesting a cumulative benefit of MCT oil application. The greatest difference was noted at Week 6, where the MCT group showed a 38.84% weight gain versus 33.95% in the coconut oil group, highlighting both statistical and clinical relevance. While effect sizes returned to the small range at Weeks 7 and 8, the absolute differences in mean percentage weight gain remained clinically meaningful. Table 4: Percentage Weight Gain from Birth Between Groups (Week 1 to 8) Weeks Group Weight Gain (%) t (df) pvalue* 95% CI Cohen’s d Effect Size Week 1 MCT -0.47 ± 3.34 -0.62 (197) 0.536 [-1.16, 0.61] 0.09 Very small Coconut oil -0.74 ± 2.92 Week 2 MCT 6.91 ± 4.44 -1.38 (197) 0.168 [-1.99, 0.35] 0.20 Very small Coconut oil 6.09 ± 3.85 Week 3 MCT 14.70 ± 5.87 -2.63 (197) 0.009 [-3.54, -0.50] 0.37 Small Coconut oil 12.69 ± 4.84 Week 4 MCT 22.92 ± 7.13 -3.12 (197) 0.002 [-4.84, -1.08] 0.44 Small Coconut oil 19.96 ± 6.16 Week 5 MCT 30.84 ± 8.11 -3.59 (197) <0.001 [-6.03, -1.74] 0.51 Medium Coconut oil 26.95 ± 7.07 Week 6 MCT 38.84 ± 9.13 -3.96 (197) <0.001 [-7.33, -2.44] 0.56 Medium Coconut oil 33.95 ± 8.19 Week 7 MCT 47.27 ± 11.49 -3.34 (197) 0.001 [-8.32, -2.13] 0.47 Small Coconut oil 42.05 ± 10.47 Week 8 MCT 56.48 ± 12.92 -3.47 (198) 0.001 [-9.80, - 2.67] 0.49 Small Coconut oil 50.25 ± 12.45 Data presented as Mean ± SD. *A p-value of less than 0.05 was considered statistically significant. MCT: Medium-chain triglyceride. Dr. Vinay V. Kulkarni, et al. Effect Of Medium-Chain Triglyceride Oil Massage On Postnatal Weight Gain In Term And Late Preterm Neonates: A Randomized Controlled Trial. Int. J Med. Pharm. Res., 6 (5): 936‐947, 2025 943 Percentage Weight Gain from Week 2 Baseline Percentage weight gain from week 2 to weeks 4, 6, and 8 was also significantly higher in the MCT oil group compared to the coconut oil group at all three intervals (Table 5). The magnitude of divergence increased over time, indicating a sustained and cumulative benefit associated with MCT oil application. Effect sizes across these intervals were in the medium range (Cohen’s d = 0.51-0.61), supporting both statistical significance and clinical relevance of the observed differences. Table 5: Comparison of Percentage Weight Gain from Week 2 Baseline Weeks Group Weight Gain (%) t (df) pvalue* 95% CI Effect Size (Cohen's d) Effect Size Week 4 vs 2 MCT 14.95 ± 3.88 -3.73 (197) <0.001 [-2.91, -0.89] 0.53 Medium Coconut oil 13.05 ± 3.24 Week 6 vs 2 MCT 29.83 ± 5.96 -4.27 (197) <0.001 [-5.25, -1.92] 0.61 Medium Coconut oil 26.25 ± 5.87 Week 8 vs 2 MCT 46.36 ± 9.60 -3.61 (197) <0.001 [-7.68, -2.24] 0.51 Medium Coconut oil 41.40 ± 9.75 Data presented as Mean ± SD. *A p-value of less than 0.05 was considered statistically significant. MCT: Medium-chain triglyceride. Subgroup Analysis Weekly weight gain from birth to 8 weeks in the late preterm neonates subgroup In term neonates, the MCT oil group exhibited a consistent advantage in weight gain over the coconut oil group beginning in week 3. In late preterm neonates, who are more vulnerable to extrauterine growth restriction, early weight gain patterns were similar across both groups. However, significant differences were observed by week 6 (Table 6). Among late preterm neonates, the MCT group demonstrated statistically significantly greater weight gain compared to the coconut oil group from Week 3 onward. In this subgroup, effect sizes increased progressively over time, transitioning from small to large, and peaking between Weeks 5 and 8. Notably, at Week 6, a large effect size was observed (Cohen’s d=0.82), indicating a substantial and clinically meaningful benefit of MCT oil application. Table 6: Weekly weight gain from birth to 8 weeks in late preterm neonates subgroup Week Group Weight gain (kg) t (df) pvalue 95% CI Effect Size (Cohen's d) Effect Week 1 MCT -0.01 ± 0.09 -0.50 (99) 0.618 [-0.04, 0.02] 0.10 Very small Coconut oil -0.02 ± 0.08 Week 2 MCT 0.19 ± 0.12 -1.21 (99) 0.228 [-0.07, 0.02] 0.24 Small Coconut oil 0.16 ± 0.10 Week 3 MCT 0.39 ± 0.15 -1.98 (99) 0.050 [-0.10, 0.00] 0.39 Small Coconut oil 0.34 ± 0.11 Week 4 MCT 0.61 ± 0.18 -2.33 (99) 0.022 [-0.14, -0.01] 0.46 Small Coconut oil 0.54 ± 0.14 Week 5 MCT 0.84 ± 0.21 -3.44 (99) 0.001 [-0.19, -0.05] 0.68 Medium Coconut oil 0.71 ± 0.15 Week 6 MCT 1.05 ± 0.22 -4.11 (99) <0.001 [-0.24, -0.08] 0.82 Large Coconut oil 0.89 ± 0.17 Week 7 MCT 1.30 ± 0.36 -2.52 (99) 0.013 [-0.31, -0.04] 0.50 Medium Coconut oil 1.13 ± 0.33 Week 8 MCT 1.55 ± 0.35 -2.82 (99) 0.006 [-0.33, -0.06] 0.56 Medium Coconut oil 1.36 ± 0.33 Data presented as Mean ± SD. *A p-value of less than 0.05 was considered statistically significant. MCT: Medium-chain triglyceride. Percentage weight gain from week 2 to weeks 4, 6, and 8 in late preterm neonates’ subgroup Among late preterm neonates, percentage weight gain from Week 2 to Week 4 was higher in the MCT group compared to the coconut oil group; however, the difference did not reach statistical significance (p=0.086). However, the effect size (Cohen’s d=0.34) indicates a small potential effect. By Week 6, the MCT group exhibited significantly greater weight gain (p=0.003), with a moderate effect size (d=0.61), suggesting a meaningful clinical impact. This trend continued through Week 8, where the MCT group maintained significantly higher weight gain (p=0.032), accompanied by a small but meaningful effect size (d=0.43), indicating a sustained benefit of MCT oil on postnatal growth in this subgroup. Dr. Vinay V. Kulkarni, et al. Effect Of Medium-Chain Triglyceride Oil Massage On Postnatal Weight Gain In Term And Late Preterm Neonates: A Randomized Controlled Trial. Int. J Med. Pharm. Res., 6 (5): 936‐947, 2025 944 Table 7: Percentage weight gain from week 2 to weeks 4, 6, and 8 in late preterm neonates’ subgroup Week Group Weight gain (%) t (df) pvalue* 95% CI Effect Size (Cohen's d) Effect Week 4 vs 2 MCT 15.49 ± 4.09 -1.73 (99) 0.086 [-2.84, 0.19] 0.34 Small Coconut oil 14.16 ± 3.58 Week 6 vs 2 MCT 31.69 ± 6.52 -3.06 (99) 0.003 [-6.59, -1.40] 0.61 Medium Coconut oil 27.69 ± 6.61 Week 8 vs 2 MCT 49.17 ± 10.44 -2.17 (99) 0.032 [-8.75, -0.39] 0.43 Small Coconut oil 44.60 ± 10.72 Data presented as Mean ± SD. *A p-value of less than 0.05 was considered statistically significant. MCT: Medium-chain triglyceride. Secondary Outcomes Safety and Tolerability No serious adverse events were reported in either group throughout the study period. Both MCT oil and coconut oil were well tolerated, with no instances requiring discontinuation of massage due to oil-related complications. Vital signs, thermoregulation, and overall clinical well-being remained stable across both groups, and no systemic adverse reactions were observed. Local skin reactions were infrequent and mild. Transient erythema at the site of massage was noted in two neonates (2.1%) in the coconut oil group and three neonates (2.9%) in the MCT oil group. All cases resolved spontaneously within 24 to 48 hours without the need for medical intervention. Importantly, no cases of skin breakdown, peeling, dermatitis, rash, pruritus, or infection were recorded in either group. These findings support the safety and tolerability of both oils for routine use in neonatal massage. Caregiver Acceptability and Compliance Caregiver compliance was excellent in both groups. High massage adherence (>90% of scheduled sessions) was achieved by 93.7% of caregivers in the coconut oil group (89 out of 95) and 92.4% in the MCT oil group (97 out of 105). All caregivers received standardized training through demonstrations at enrollment, and weekly follow-ups by health staff confirmed ongoing adherence. No caregivers declined their assigned oil after randomization, and all were able to perform the oil massage correctly under supervision following initial instruction. There were no dropouts attributed to refusal to apply the oils. Subjective feedback from caregivers indicated high acceptability of both oils. Commonly cited factors supporting continued use included ease of application, pleasant texture and scent, and perceived improvements in infant behavior. Ancillary Observations on Feeding and Sleep Caregivers in both groups informally reported perceived improvements in infant feeding and sleep patterns, particularly after the third week of intervention. Increased feeding demand was noted more frequently in the MCT oil group, with 42 caregivers (40%) informally reporting greater appetite or more frequent feeding. Improvements in night -time sleep were mentioned by caregivers in both groups, with slightly higher reporting in the MCT group (47 caregivers, 44.7%) compared to the coconut oil group (39 caregivers, 41.0%). These subjective reports, though not formally quantified, suggest potential additional benefits of oil massage as perceived by caregivers, particularly in the MCT oil group. DISCUSSION This double-blind randomized controlled trial was designed to evaluate the comparative effects of MCT oil and coconut oil massage on postnatal weight gain in term and late preterm neonates. The findings clearly demonstrate that MCT oil massage was superior to coconut oil in promoting weight gain across all postnatal weeks of observation. The strong baseline comparability between the two groups ensured that observed differences in outcomes could be primarily attributed to the massage intervention, rather than underlying demographic or clinical disparities. Our findings demonstrated that massage with MCT oil resulted in significantly greater weight gain than coconut oil massage, with differences becoming statistically significant by the third week and peaking by the sixth week of life. These findings suggest a sustained anabolic benefit of MCT oil during a critical window of neonatal growth. The superior performance of MCT oil aligns with prior hypotheses and clinical evidence. Saeadi et al. demonstrated that MCT oil massage significantly improves weight gain in preterm infants, attributing this to the small molecular size and high lipid solubility of caprylic (C8) and capric (C10) acids, which enhance dermal absorption and energy availability.14 A study by Liao et al. also showed that daily massage with MCT oil is an effective intervention for promoting weight gain in preterm infants and should be integrated into developmental care for low-birth-weight infants.12 In contrast, although coconut oil is rich in lauric acid and widely accepted for its moisturizing and antimicrobial effects, its higher molecular weight and viscosity may hinder effective transdermal penetration.5,15 In line with the findings of studies by Saeadi et al. and Liao et al., subgroup analysis in our study also highlighted the value of MCT oil in late preterm infants, who are particularly vulnerable to extrauterine growth restriction. Between Weeks 2 and 6, weight gain in the MCT group was significantly greater than in the coconut oil group. This subgroup analysis reinforced that the anabolic advantage of MCT oil extends