{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:07:28Z","timestamp":1789380448992,"version":"build-2803163510"},"reference-count":30,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Feeding difficulties are common during bronchiolitis hospitalization and may lead to reduced caloric intake. Evidence evaluating the relationship between caloric adequacy and hospital length of stay (LOS) remains limited. We aimed to characterize daily caloric adequacy during bronchiolitis hospitalization and evaluate its relationship with LOS. Methods: An ambispective cohort study included children younger than 2 years hospitalized with bronchiolitis between 2013 and 2023 at a tertiary hospital in Valencia, Spain. Caloric adequacy was calculated as the percentage of WHO\/FAO estimated caloric requirements achieved, including all nutritional and intravenous caloric sources. Associations with LOS were evaluated using correlation and multivariable regression analyses. Results: A total of 613 patients were included, with caloric intake data available for 607. Median LOS was 5 days (IQR 3\u20137). Lower caloric adequacy during the first days of hospitalization was associated with longer LOS. Hospitalization day 2 showed the strongest early association with LOS (\u03c1 = \u22120.230; p &lt;0.001). After multivariable adjustment, each 10-percentage-point increase in day-2 caloric adequacy was associated with a 3.32% shorter LOS (95% CI, 1.74\u20134.87%; p &lt; 0.001); subgroup associations were mainly observed in children younger than 12 months and were strongest in those with moderate acute malnutrition. Patients with longer LOS showed delayed achievement of \u226580% caloric adequacy, particularly those with LOS \u2265 9 days (day 6). Conclusions: Early caloric adequacy was associated with LOS in children hospitalized with bronchiolitis. Failure to achieve \u226580% within the first 48 h may serve as an early marker of a slower clinical course.<\/jats:p>","DOI":"10.3390\/nu18182989","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T09:34:01Z","timestamp":1789378441000},"page":"2989","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Caloric Adequacy and Hospital Length of Stay in Children Younger than Two Years Hospitalized with Bronchiolitis"],"prefix":"10.3390","volume":"18","author":[{"given":"Ana","family":"Barr\u00e9s-Fern\u00e1ndez","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Hospital Cl\u00ednic Universitari de Val\u00e8ncia, 46010 Valencia, Spain"},{"name":"INCLIVA Health Research Institute, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1660-6993","authenticated-orcid":false,"given":"Jos\u00e9 Vicente","family":"Arcos-Machancoses","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital Cl\u00ednic Universitari de Val\u00e8ncia, 46010 Valencia, Spain"},{"name":"INCLIVA Health Research Institute, 46010 Valencia, Spain"},{"name":"Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0121-2676","authenticated-orcid":false,"given":"Silvia","family":"Castillo-Corull\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital Cl\u00ednic Universitari de Val\u00e8ncia, 46010 Valencia, Spain"},{"name":"INCLIVA Health Research Institute, 46010 Valencia, Spain"},{"name":"Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Ferrando-Monle\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital Cl\u00ednic Universitari de Val\u00e8ncia, 46010 Valencia, Spain"},{"name":"Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6956-9321","authenticated-orcid":false,"given":"Caterina","family":"Calderon","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology and Psychobiology, University of Barcelona, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Mart\u00ednez-Costa","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital Cl\u00ednic Universitari de Val\u00e8ncia, 46010 Valencia, Spain"},{"name":"INCLIVA Health Research Institute, 46010 Valencia, Spain"},{"name":"Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/S0140-6736(16)30951-5","article-title":"Viral Bronchiolitis","volume":"389","author":"Florin","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e1474","DOI":"10.1542\/peds.2014-2742","article-title":"Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis","volume":"134","author":"Ralston","year":"2014","journal-title":"Pediatrics"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ali, S., Plint, A.C., and Klassen, T.P. (2012). Bronchiolitis. Kendig & Chernick\u2019s Disorders of the Respiratory Tract in Children, Elsevier.","DOI":"10.1016\/B978-1-4377-1984-0.00027-9"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.arcped.2020.10.004","article-title":"Simple Actions to Support Breastfeeding Can Avoid Unwanted Weaning in Infants Younger than 6 Months Hospitalized for Bronchiolitis: A before\/after Study (Bronchilact II)","volume":"28","author":"Heilbronner","year":"2021","journal-title":"Arch. Pediatr."},{"key":"ref_5","first-page":"e13896","article-title":"Method of Hydration for Infants Admitted with Bronchiolitis: Physician or Parental Choice?","volume":"13","author":"Saqib","year":"2021","journal-title":"Cureus"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1044\/2021_PERSP-21-00152","article-title":"Treatment of Pediatric Patients with High-Flow Nasal Cannula and Considerations for Oral Feeding: A Review of the Literature","volume":"7","author":"Rice","year":"2022","journal-title":"Perspect. ASHA Spec. Interest Groups"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.1111\/all.15997","article-title":"A Systematic Review and Meta-Analysis on Nutritional and Dietary Interventions for the Treatment of Acute Respiratory Infection in Pediatric Patients: An EAACI Taskforce","volume":"79","author":"Milani","year":"2024","journal-title":"Allergy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1177\/0115426595010005177","article-title":"Body Composition and Nutrition Support in Pediatrics: What to Defend and How Soon to Begin","volume":"10","author":"Cunningham","year":"1995","journal-title":"Nutr. Clin. Pract."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1177\/0148607117711387","article-title":"Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition","volume":"41","author":"Mehta","year":"2017","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_10","unstructured":"Duggan, C., Watkins, J.B., and Koletzko, B. (2008). Nutritional Support of the Critically Ill Child. Nutrition in Pediatrics, BC Decker Inc.. [4th ed.]."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1016\/j.clnu.2004.05.006","article-title":"The Effect of Cumulative Energy and Protein Deficiency on Anthropometric Parameters in a Pediatric ICU Population","volume":"23","author":"Hulst","year":"2004","journal-title":"Clin. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1542\/hpeds.2012-0032","article-title":"Relationship Between Caloric Intake and Length of Hospital Stay for Infants with Bronchiolitis","volume":"3","author":"Weisgerber","year":"2013","journal-title":"Hosp. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1002\/jhm.903","article-title":"Factors Predicting Prolonged Hospital Stay for Infants with Bronchiolitis","volume":"6","author":"Weisgerber","year":"2011","journal-title":"J. Hosp. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Barr\u00e9s-Fern\u00e1ndez, A., Arcos-Machancoses, J.V., Castillo-Corull\u00f3n, S., Gonz\u00e1lez, S.I., Fullana-Tur, M., and Ferrando-Monle\u00f3n, S. (2025). Estimating Caloric Intake per Breastfeeding Session in Infants: A Probabilistic Approach. Nutrients, 17.","DOI":"10.20944\/preprints202509.0851.v1"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1001\/archpedi.1983.02140270007003","article-title":"Bronchiolitis. What\u2019s in the Name?","volume":"137","author":"McConnochie","year":"1983","journal-title":"Am. J. Dis. Child."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1001\/archpedi.1972.02110090097011","article-title":"A Clinical Scoring System for the Diagnosis of Respiratory Failure. Preliminary Report on Childhood Status Asthmaticus","volume":"123","author":"Wood","year":"1972","journal-title":"Am. J. Dis. Child."},{"key":"ref_17","first-page":"37","article-title":"Subcutaneous adrenaline versus inhaled salbutamol in the treatment of childhood asthmatic crisis","volume":"27","year":"1987","journal-title":"An. Esp. Pediatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1002\/ppul.23546","article-title":"Bronchiolitis Score of Sant Joan de D\u00e9u: BROSJOD Score, Validation and Usefulness","volume":"52","author":"Balaguer","year":"2017","journal-title":"Pediatr. Pulmonol."},{"key":"ref_19","unstructured":"WHO (1985). Energy and Protein Requirements. Report of a Joint FAO\/WHO\/UNU Expert Consultation, WHO. World Health Organization Technical Report Series 724."},{"key":"ref_20","unstructured":"FAO, WHO, and UNU (2004). Human Energy Requirements: Report of a Joint FAO\/WHO\/UNU Expert Consultation, Rome, 17\u201324 October 2001, Food and Agriculture Organization of the United Nations. FAO Food and Nutrition Technical Report Series No. 1."},{"key":"ref_21","first-page":"393","article-title":"F\u00f3rmulas de nutrici\u00f3n enteral pedi\u00e1trica. \u00bfC\u00f3mo elegir la adecuada?","volume":"69","year":"2011","journal-title":"Acta Pediatr. Esp."},{"key":"ref_22","unstructured":"(2026, June 03). WHO Child Growth Standards: Length\/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development. Available online: https:\/\/www.who.int\/publications\/i\/item\/924154693X."},{"key":"ref_23","unstructured":"(2025, July 22). IBM SPSS Statistics. Available online: https:\/\/www.ibm.com\/es-es\/products\/spss-statistics."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4015","DOI":"10.1007\/s00431-023-05085-y","article-title":"Association of Enteral Feeds in Critically Ill Bronchiolitis Patients Supported by High-Flow Nasal Cannula with Adverse Events and Outcomes","volume":"182","author":"Sarkis","year":"2023","journal-title":"Eur. J. Pediatr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e71279","DOI":"10.1002\/ppul.71279","article-title":"Implementation of a Feeding Protocol in Patients with Humidified HIGH Flow Nasal Cannula in a Pediatric Intensive Care Unit Improves Enteral Nutrition: The HIGHPE Study","volume":"60","author":"Stacey","year":"2025","journal-title":"Pediatr. Pulmonol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"E43","DOI":"10.12788\/jhm.3306","article-title":"Feeding during High-Flow Nasal Cannula for Bronchiolitis: Associations with Time to Discharge","volume":"14","author":"Shadman","year":"2019","journal-title":"J. Hosp. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1080\/09637486.2016.1245714","article-title":"Nutritional Status, Metabolic State and Nutrient Intake in Children with Bronchiolitis","volume":"68","author":"Mehta","year":"2017","journal-title":"Int. J. Food Sci. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s00134-019-05922-5","article-title":"Nutritional Support for Children during Critical Illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) Metabolism, Endocrine and Nutrition Section Position Statement and Clinical Recommendations","volume":"46","author":"Tume","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_29","unstructured":"(2026, May 17). WHO Guideline for Complementary Feeding of Infants and Young Children 6\u201323 Months of Age. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240081864."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1542\/peds.2007-1135","article-title":"Effect of Oxygen Supplementation on Length of Stay for Infants Hospitalized with Acute Viral Bronchiolitis","volume":"121","author":"Unger","year":"2008","journal-title":"Pediatrics"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/18\/2989\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T09:43:50Z","timestamp":1789379030000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/18\/2989"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,12]]},"references-count":30,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["nu18182989"],"URL":"https:\/\/doi.org\/10.3390\/nu18182989","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,12]]}}}