Enteral olive oil supplementation as a rescue strategy for caloric insufficiency in critically ill neonates: a retrospective cohort study

To evaluate the feasibility and short-term growth outcomes associated with enteral olive oil supplementation in critically ill neonates who were unable to meet daily caloric requirements due to feeding intolerance or fluid restrictions. This retrospective cohort study included 38 neonates admitted to a Level IV neonatal intensive care unit (NICU) between January 2018 and January 2025 who received enteral olive oil supplementation because of insufficient caloric intake despite standard nutritional interventions. Olive oil was started at 1 mL/kg/day and adjusted based on clinical tolerance. Pre- and post-supplementation comparisons were performed for caloric intake (kcal/kg/day), daily weight gain (g/day), weekly head circumference growth (cm/week), weight-for-age and head circumference-for-age Z-scores, and macronutrient energy distribution, as well as clinically documented complications, including gastrointestinal events, respiratory outcomes, and sepsis. The mean gestational age was 36 ± 4 weeks and mean birth weight was 2291 ± 826 g. Following supplementation, median caloric intake increased significantly (98.4 to 119.4 kcal/kg/day, p < 0.001), along with daily weight gain (7.5 to 20 g/day, p < 0.001) and weekly head circumference growth (0.70 to 0.96 cm/week, p < 0.001). Weight-for-age and head circumference-for-age Z-scores showed modest but significant improvement. No increase in clinically documented gastrointestinal or respiratory complications was observed during the supplementation period, and sepsis rates remained unchanged. In this selected cohort of critically ill neonates, enteral olive oil supplementation was associated with increased caloric intake and improved short-term growth parameters. Given the retrospective design, small sample size, and absence of a comparator group, these findings should be interpreted as descriptive and hypothesis-generating.