The Effectiveness of Virgin Coconut Oil Application on Improving The Skin Integrity of Preterm Infants: Systematic Review and Metaanalysis with Neonatal Skin Condition Score as the Parameter

Background: Preterm infants have a greater susceptibility to serious infections because their skin barrier has not fully functioned properly. Early birth in preterm infants causes immaturity of the barrier development, in the form of a thinner stratum corneum. Therefore extra care is needed to maintain the integrity of their skin to prevent infection, where the main recommendation is the administration of emollients, such as coconut oil. Virgin coconut oil contains nutrients and lauric acid that are more maintained and higher than coconut oil. Changes in skin integrity can cause extensive skin damage and become risk factors for infection. Erythema or damage to the skin such as erosion, excoriation, or crusting can be an early symptom of life-threatening infection in preterm infants. Assessment of skin integrity can be assessed objectively using the Neonatal Skin Condition Score (NSCS). Virgin coconut oil as an emollient with its antimicrobial activity is expected to allow improvement of the barrier structure of the skin. Aim: The purpose of this study is to review previous studies to provide a systematic summary of the effectiveness of topical coconut oil in improving the skin integrity of premature infants. Methods: Searching the electronic database Pubmed-MEDLINE, Scopus, ProQuest, Cochrane library, ClinicalTrials.gov, and Google Scholar, found five most relevant articles included in the qualitative and two of those five articles included in the meta-analysis. Result: The meta-analysis of the effect of topical VCO compared with control on NSCS values in preterm infants showed the value of heterogeneity test with Tau2=0.04 df=1; p=0.13, I2=55%. The value of the Q statistic was z value = 5.23 (p < 0.001). This shows that the overall administration of topical VCO can significantly improve the value of NSCS on preterm infants. The results of the overall meta-analysis showed that the overall standardized mean difference in NSCS between the intervention group compared to control was -0.93[-1.28 -0.58] (p < 0.001). These results indicate that the overall NSCS value of the intervention group was significantly better than the control group. Conclusion: Data from a systematic review and meta-analysis showed that the application of VCO can provide significantly better results in improving the skin integrity of preterm infants.