A randomised clinical trial was conducted to explore the effect of orally supplemented medium-chain fatty acids (MCFA) to heifers and cows starting 6–8 weeks prior to expected calving date on blood and milk polymorphonuclear neutrophilic leucocyte (PMNL) apoptosis between 1 and 3 d in milk (DIM). The effects of MCFA-supplementation on the likelihood of intramammary infections (IMI) in early lactation, and test-day somatic cell count (SCC) and average daily milk yield (MY) during the first 4 months of lactation were evaluated as well. Twenty-two animals were included of which half were orally supplemented with MCFA starting 6–8 weeks prior to calving and half served as non-supplemented controls. The PMNL viability in both blood and milk was quantified using dual-colour flow cytometry with fluorescein-labelled annexin and propidium iodide. In non-supplemented animals, % blood PMNL apoptosis significantly increased between start of supplementation and early lactation, reflecting a potential reduction in innate immune capacity, whereas this was not true in the MCFA-supplemented animals. Similar results were seen in milk PMNL apoptosis. Overall, the % apoptotic milk PMNL between 1 and 3 DIM was significantly lower in the MCFA-supplemented group compared with the non-supplemented group. There was no substantial effect of oral MCFA-supplementation on the likelihood of quarter IMI nor on the composite test-day milk SCC or average daily MY. In conclusion, oral MCFA-supplementation starting 6–8 weeks before expected calving date supported the blood and milk neutrophil viability in early lactating dairy cows. Still, this was not reflected in an improvement of udder health nor MY in early and later lactation. The results should trigger research to further unravel the mechanisms behind the observed immunomodulating effect, and the potential relevance for the cows' performances throughout lactation.