Medium-chain triglyceride supplementation in preterm infants: a prospective cohort study

BACKGROUND & AIMS: Optimizing postnatal growth in preterm infants remains a challenge in neonatal care. Medium-chain triglycerides (MCT) are rapidly absorbed and metabolized, increasing energy availability and potentially enhancing growth. However, prospective data examining how MCT supplementation is used in routine neonatal care and its relationship with indicators of clinical complexity in preterm infants are still limited. The objective was to investigate the use of MCT supplementation in preterm infants and its relationship with indicators of greater clinical complexity in routine neonatal care. MATERIALS AND METHODS: This prospective cohort included preterm infants with gestational age at birth <37 weeks and birth weight <2.500 g admitted to a neonatal intensive care unit (NICU). Infants were stratified according to MCT supplementation status. Baseline anthropometric and birth characteristics were described, and associations between birth characteristics and clinical outcomes, as well as between anthropometric parameters and NICU length of stay, were analyzed according to MCT use. RESULTS: The cohort included 76 participants, however MCT analyses were limited to 73 cases with complete data, most of whom were very or extremely preterm (71.1%). Supplementation was more frequent among those with greater prematurity, low birth weight, bronchopulmonary dysplasia (BPD), and extrauterine growth restriction (EUGR) (p < 0.05). Among preterm infants who received MCT supplementation, only 9% maintained adequate weight at hospital discharge (p = 0.002), the greatest drop in weight Z-score (p < 0.001), and longer hospital stays (p = 0.004). CONCLUSIONS: In this prospective exploratory cohort, MCT supplementation was more frequently administered to preterm infants with greater clinical severity, including those with lower gestational age, low birth weight, BPD, and EUGR. Due to the limited sample size and observational design, the findings should be interpreted as hypothesis-generating. More robust studies are needed to clarify the role of MCT supplementation in neonatal nutrition.