Addressing Prematurity: Evidence-Based Interventions and the Role of Topical Emollient Therapy

Prematurity remains a major global health challenge, contributing significantly to neonatal mortality and long-term complications among survivors. According to the Global Burden of Disease study, prematurity is the leading cause of illness worldwide. In response, the World Health Organization (WHO) and UNICEF launched the Every Newborn Action Plan in 2014, aiming to reduce preventable newborn deaths and stillbirths by 2035 (1,2). Simple, low-cost interventions have the potential to prevent or manage up to 70%–80% of neonatal deaths. However, in many low- and middle-income countries, these interventions are not adequately implemented due to barriers in providing accessible, affordable, and appropriate maternal and neonatal care. Clinical guidelines play a critical role in consolidating the most up-to-date evidence to support decision-making, enhance quality of care, improve outcomes, and ensure cost-effectiveness. Unfortunately, in many settings, evidence-based strategies are either overlooked or implemented incorrectly, limiting their impact (2–4).One traditional practice with growing scientific interest is the use of oil massage in newborn care. In many cultures, massaging infants with various oils, such as sunflower, coconut, mustard, and vegetable oils, is a long-standing custom, believed to offer multiple health benefits. The WHO currently provides evidence-based recommendations for skin care in preterm neonates, yet there is ongoing debate about the efficacy and safety of different emollient oils used topically (2,5).

Emollient oils have been recognized for their ability to support skin integrity, minimize transepidermal water loss, and provide essential moisturization, especially critical in preterm infants whose skin barrier is underdeveloped. Evidence shows that the use of coconut oil in particular is associated with a significant reduction in infection risk. Preterm infants massaged with coconut oil had a 39% lower risk of infection compared to controls. Moreover, infants who received massages twice daily or for a duration exceeding two weeks experienced a 40%  and 31%  reduction in infection risk, respectively. High-quality studies further support a 35% reduction in infections among those who received topical oil therapy (2,6,7). These findings reinforce the hypothesis that topical oil application may offer protective benefits beyond basic skin care in preterm infants. Consistent with prior Cochrane reviews, the results highlight the potential of emollient oils in infection prevention. The mechanisms behind this effect likely involve the strengthening of the skin barrier, which acts as a physical shield against microbial invasion. Additionally, the moisturizing properties of these oils help maintain skin hydration and resilience, further supporting the skin’s natural defenses (2).

References:

1.         Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016 - The Lancet [Internet]. [cited 2025 May 30]. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32152-9/fulltext

2.         Getaneh FB, Asmare A, Abayneh B, Birre E, Mohammed A, Muche A, et al. Infection in preterm infants receiving topical emollient oil massage: a systematic review and meta-analysis of randomised control trials. BMJ Paediatr Open. 2024 Jul 9;8(1):e002364.

3.         Abouelfettoh A, Ludington-Hoe SM, Burant CJ, Visscher MO. Effect of Skin-To-Skin Contact on Preterm Infant Skin Barrier Function and Hospital-Acquired Infection. J Clin Med Res. 2011 Feb 12;3(1):36–46.

4.         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 Nov 26;5(11):689–93.

5.         Liao YC, Wan YH, Chen PH, Hsieh LY. Efficacy of medium-chain triglyceride oil massage on growth in preterm infants: a randomized controlled trial: A CONSORT-compliant article. Medicine (Baltimore). 2021 Jul 30;100(30):e26794.

6.         Darmstadt GL, Saha SK. Traditional practice of oil massage of neonates in Bangladesh. J Health Popul Nutr. 2002 Jun;20(2):184–8.

7.         Opportunities for Improving, Adapting and Introducing Emollient Therapy and Improved Newborn Skin Care Practices in Africa | Journal of Tropical Pediatrics | Oxford Academic [Internet]. [cited 2025 May 30]. Available from: https://academic.oup.com/tropej/article-abstract/58/2/88/1635427?redirectedFrom=fulltext