BACKGROUND:Death anxiety is common in advanced cancer, but little is known about risk factors for its occurrence, frequency or severity in those receiving specialized palliative care. AIM:This study aimed to determine the prevalence and correlates of death anxiety in outpatients with advanced cancer receiving specialized palliative care. DESIGN:Cross-sectional observational study. SETTING/PARTICIPANTS:We identified the prevalence of death anxiety in 203 patients with advanced cancer attending an outpatient palliative care clinic in a large tertiary care hospital, and examined its association with sociodemographic factors, time since advanced cancer diagnosis, time since initial palliative care consultation, and proximity to death. Death anxiety was measured using the Death and Dying Distress Scale (DADDS). Variables that demonstrated significant univariable associations were subsequently included in a multivariable regression analysis. RESULTS:Moderate to severe death anxiety (DADDS score ⩾ 25) was reported by 46.3% of participants. Multivariable analysis demonstrated that greater death anxiety was associated with lower household income (⩾$100,000+ vs <$30,000: ß = -0.30, p = 0.002; $60,000-$99,999 vs <$30,000: ß = -0.27, p = 0.004; $30,000-$59,999 vs <$30,000: ß = -0.31, p < 0.001) and living alone (ß = 0.16, p = 0.03), but not with time since advanced cancer diagnosis or initial palliative care consultation, or with proximity to death. CONCLUSIONS:Moderate to severe death anxiety is reported by almost half of patients with advanced cancer receiving outpatient palliative care and is associated with economic disadvantage and solitary living arrangements. Further research is needed to determine to what extent targeted psychosocial and palliative interventions can alleviate such distress in this population.

BACKGROUND:Individuals with advanced cancer face the challenge of remaining engaged in life, while also contemplating death. However, there has been no validated measure of the adaptive capacity to balance these tasks, which has been termed "double awareness." AIMS:This study aimed to evaluate the psychometric properties of the novel Double Awareness Scale (DAS). METHODS:Patients with advanced cancer attending an outpatient palliative care clinic (N = 197) completed the DAS and other self-report measures assessing quality of life near end of life, life completion, satisfaction with life, preparation for end of life, death anxiety, and depression. Factor structure, construct validity, and internal consistency of the DAS were evaluated, as were group differences across high, intermediate, and low levels of double awareness. RESULTS:Factor analysis supported two factors, Life Engagement and Death Contemplation, with high internal consistency (α = 0.92 and 0.87, respectively). Life Engagement met the convergent validity criterion with quality of life near the end of life (r = 0.62) and life completion (r = 0.60), but not with life satisfaction (r = 0.46). Death Contemplation did not meet the convergent validity criterion with preparation for end of life (r = 0.23) but demonstrated discriminant validity with death anxiety (r = -0.03). Those with high levels of double awareness (high Life Engagement and high Death Contemplation) exhibited the best quality of life and lowest distress. CONCLUSIONS:Preliminary evidence supports the validity of the DAS. Further research is needed to demonstrate its validity in diverse settings, its utility in clinical care, and its responsiveness to therapeutic interventions in the context of advanced disease.

Prognostic awareness refers to a patient’s knowledge of their prognosis. Since this term implies that there is a knowable truth about survival, we propose utilizing the more neutral construct of “prognostic beliefs.” We aimed to assess prognostic beliefs of patients with cancer receiving palliative care and their relationship to: i) recall of physician-communicated prognosis, ii) physical/psychological well-being, and iii) actual survival. Participants were recruited in the outpatient palliative care clinic of a comprehensive cancer center in Toronto, Canada. Eligibility criteria were: ≥ 18 years, English-speaking, diagnosed with cancer, and receiving palliative care. Group comparisons of well-being were conducted using independent samples t-tests. 188 participants completed physical and psychosocial well-being questionnaires and the Prognostic Beliefs Questionnaire. 167/188 participants (88.8

Background: A 3-dimensional understanding of hypoplastic left heart syndrome (HLHS) and its stages of surgical palliation is crucial for pediatric cardiology trainees. Virtual reality has been used in surgical and medical fields for teaching of anatomy and physiology. An HLHS virtual reality curriculum is under development and requires a validated method to measure knowledge acquisition. Objectives: Develop and validate a multimedia assessment tool aimed at evaluating trainee knowledge of HLHS anatomy, physiology, and clinical concepts. Methods: Educational domains across each stage of HLHS palliation were identified, including anatomy, physiology, and important clinical concepts. Six cardiologists and fellows developed multiple-choice multimedia questions based on the educational domains. Six content experts took the assessment, rated question relevance to educational domains, and provided qualitative feedback. An item-level content validity index (I-CVI) was calculated for each question. Any questions with <= 50 % correct responses or I-CVI <0.78 was removed. Scale-level content validity index (S-CVI) was determined for the final assessment tool, and S-CVI >= 0.90 was deemed excellent. Results: A 33-question assessment tool was developed and distributed to the content experts. The average score was 97.0 %, with only four questions having incorrect answers. No questions had <= 50 % correct responses. I-CVI was <0.78 for two questions, and one question was removed due to repetition. The S-CVI was 0.97. Qualitative feedback revealed two themes that were subsequently addressed: marginal image and video quality for certain questions and the exclusive use of hemi-Fontan and bidirectional Glenn to describe stage II procedures. Following these changes, a final 30-question validated assessment tool was created. Conclusion: Evaluation of new curricula is aided by use of validated methods for assessment. Here, we demonstrate an effective iterative method for developing and validating an assessment tool to evaluate trainee knowledge of HLHS and its stages of surgical palliation.

Importance In clinical trials, the early or accelerated continuous renal replacement therapy (CRRT) initiation strategy among adults with acute kidney injury or volume overload has not demonstrated a survival benefit. Whether the timing of initiation of CRRT is associated with outcomes among children and young adults is unknown.Objective To determine whether timing of CRRT initiation, with and without consideration of volume overload (VO; <10% vs >= 10%), is associated with major adverse kidney events at 90 days (MAKE-90).Design, Setting, and Participants This multinational retrospective cohort study was conducted using data from the Worldwide Exploration of Renal Replacement Outcome Collaborative in Kidney Disease (WE-ROCK) registry from 2015 to 2021. Participants included children and young adults (birth to 25 years) receiving CRRT for acute kidney injury or VO at 32 centers across 7 countries. Statistical analysis was performed from February to July 2023.Exposure The primary exposure was time to CRRT initiation from intensive care unit admission.Main Outcomes and measures The primary outcome was MAKE-90 (death, dialysis dependence, or persistent kidney dysfunction [>25% decline in estimated glomerular filtration rate from baseline]).Results Data from 996 patients were entered into the registry. After exclusions (n = 27), 969 patients (440 [45.4%] female; 16 (1.9%) American Indian or Alaska Native, 40 (4.7%) Asian or Pacific Islander, 127 (14.9%) Black, 652 (76.4%) White, 18 (2.1%) more than 1 race; median [IQR] patient age, 8.8 [1.7-15.0] years) with data for the primary outcome (MAKE-90) were included. Median (IQR) time to CRRT initiation was 2 (1-6) days. MAKE-90 occurred in 630 patients (65.0%), of which 368 (58.4%) died. Among the 601 patients who survived, 262 (43.6%) had persistent kidney dysfunction. Of patients with persistent dysfunction, 91 (34.7%) were dependent on dialysis. Time to CRRT initiation was approximately 1 day longer among those with MAKE-90 (median [IQR], 3 [1-8] days vs 2 [1-4] days; P = .002). In the generalized propensity score-weighted regression, there were approximately 3% higher odds of MAKE-90 for each 1-day delay in CRRT initiation (odds ratio, 1.03 [95% CI, 1.02-1.04]).Conclusions and Relevance In this cohort study of children and young adults receiving CRRT, longer time to CRRT initiation was associated with greater risk of MAKE-90 outcomes, in particular, mortality. These findings suggest that prospective multicenter studies are needed to further delineate the appropriate time to initiate CRRT and the interaction between CRRT initiation timing and VO to continue to improve survival and reduce morbidity in this population.

PURPOSEDespite advances in palliative care in Uganda, there has been relatively little recent patient-centered research investigating end-of-life outcomes in this region. We assessed the quality of dying and death of patients with cancer in hospice care in Uganda.METHODSBereaved caregivers of patients who received hospice care in Uganda and died 2-12 months earlier (N = 201) completed the Quality of Dying and Death Questionnaire, which includes 31 items and single-item ratings of overall quality of dying and moment of death, and the FAMCARE measure of family satisfaction with cancer care.RESULTSCaregivers reported low-intermediate overall quality of dying (mean [M] standard deviation [SD], 3.25 [2.98]) and overall quality of moment of death (M [SD], 3.59 [3.51]), with 47.0% of the ratings of these two outcomes in the poor range, but the mean family satisfaction with care was high (M [SD], 77.75 [10.26]). Most Quality of Dying and Death Questionnaire items (74.2%) were rated within the intermediate range. Items rated within the good range were religious-spiritual, interpersonal, and personal facets; two items within the poor range reflected physical functioning. Overall quality of dying was most strongly correlated with pain control (Spearman's rho [rs] = 0.45, P < .001), and overall quality of moment of death with state of consciousness before death and being unafraid of dying (rs = 0.42, P < .001). The FAMCARE score was not correlated with overall quality of dying or moment of death (P = .576-.813). Only one FAMCARE item, information on managing patient's pain, was correlated with overall quality of moment of death (rs = –0.19, P = .008).CONCLUSIONEnd-of-life care in hospices in Uganda requires further improvement, particularly with regard to symptom control. Patient-centered data could bolster advocacy efforts to support quality improvement of palliative care in this and other countries.

Objective: The study objective was to determine if intraoperative peritoneal catheter placement is associated with improved outcomes in neonates undergoing high-risk cardiac surgery with cardiopulmonary bypass. Methods: This propensity score-matched - matched retrospective study used data from 22 academic pediatric cardiac intensive care units. Consecutive neonates undergoing Society of Thoracic Surgeons-European - European Association for Cardio-Thoracic Surgery category 3 to 5 cardiac surgery with cardiopulmonary bypass at centers participating in the NEonatal and Pediatric Heart Renal Outcomes Network collaborative were studied to determine the association of the use of an intraoperative placed peritoneal catheter for dialysis or passive drainage with clinical outcomes, including the duration of mechanical ventilation. Results: Among 1490 eligible neonates in the NEonatal and Pediatric Heart Renal Outcomes Network dataset, a propensity-matched analysis was used to compare 395 patients with peritoneal catheter placement with 628 patients without peritoneal catheter placement. Time to extubation and most clinical outcomes were similar. Postoperative length of stay was 5 days longer in the peritoneal catheter placement cohort (17 vs 22 days, P 1 / 4 .001). There was a 50% % higher incidence of moderate to severe acute kidney injury in the no-peritoneal catheter cohort (12% % vs 18%, % , P 1 / 4 .02). Subgroup analyses between specific fi c treatments and in highest risk patients yielded similar associations. Conclusions: This study does not demonstrate improved outcomes among neonates with placement of a peritoneal catheter during cardiac surgery. Outcomes were similar apart from longer hospital stay in the peritoneal catheter cohort. The no-peritoneal catheter cohort had a 50% % higher incidence of moderate to severe acute kidney injury (12% % vs 18%). % ). This analysis does not support indiscriminate peritoneal catheter use, although it may support the utility for postoperative fl uid removal among neonates at risk for acute kidney injury. A multicenter controlled trial may better elucidate peritoneal catheter effects. (JTCVS Open 2024;19:275-95)

Objectives To assess the prevalence and drivers of distress, a composite of burnout, decreased meaning in work, severe fatigue, poor work–life integration and quality of life, and suicidal ideation, among nurses and physicians during the COVID-19 pandemic.Design Cross-sectional design to evaluate distress levels of nurses and physicians during the COVID-19 pandemic between June and August 2021.Setting Cardiovascular and oncology care settings at a Canadian quaternary hospital network.Participants 261 nurses and 167 physicians working in cardiovascular or oncology care. Response rate was 29% (428 of 1480).Outcome measures Survey tool to measure clinician distress using the Well-Being Index (WBI) and additional questions about workplace-related and COVID-19 pandemic-related factors.Results Among 428 respondents, nurses (82%, 214 of 261) and physicians (62%, 104 of 167) reported high distress on the WBI survey. Higher WBI scores (≥2) in nurses were associated with perceived inadequate staffing (174 (86%) vs 28 (64%), p=0.003), unfair treatment, (105 (52%) vs 11 (25%), p=0.005), and pandemic-related impact at work (162 (80%) vs 22 (50%), p<0.001) and in their personal life (135 (67%) vs 11 (25%), p<0.001), interfering with job performance. Higher WBI scores (≥3) in physicians were associated with perceived inadequate staffing (81 (79%) vs 32 (52%), p=0.001), unfair treatment (44 (43%) vs 13 (21%), p=0.02), professional dissatisfaction (29 (28%) vs 5 (8%), p=0.008), and pandemic-related impact at work (84 (82%) vs 35 (56%), p=0.001) and in their personal life (56 (54%) vs 24 (39%), p=0.014), interfering with job performance.Conclusion High distress was common among nurses and physicians working in cardiovascular and oncology care settings during the pandemic and linked to factors within and beyond the workplace. These results underscore the complex and contextual aspects of clinician distress, and the need to develop targeted approaches to effectively address this problem.

Abstract Background Family physicians' (FPs) long‐term relationships with their oncology patients position them ideally to provide primary palliative care, yet their involvement is variable. We examined perceptions of FP involvement among outpatients receiving palliative care at a cancer center and identified factors associated with this involvement. Methods Patients with advanced cancer attending an oncology palliative care clinic (OPCC) completed a 25‐item survey. Eligible patients had seen an FP within 5 years. Binary multivariable logistic regression analyses were conducted to identify factors associated with (1) having seen an FP for palliative care within 6 months, and (2) having a scheduled/planned FP appointment. Results Of 258 patients, 35.2% (89/253) had seen an FP for palliative care within the preceding 6 months, and 51.2% (130/254) had a scheduled/planned FP appointment. Shorter travel time to FP (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.48–0.93, p = 0.02), the FP having a 24‐h support service (OR = 1.96, 95% CI = 1.02–3.76, p = 0.04), and a positive perception of FP's care (OR = 1.05, 95% CI = 1.01–1.09, p = 0.01) were associated with having seen the FP for palliative care. English as a first language (OR = 2.90, 95% CI = 1.04–8.11, p = 0.04) and greater ease contacting FP after hours (OR = 1.33, 95% CI = 1.08–1.64, p = 0.008) were positively associated, and female sex of patient (OR = 0.51, 95% CI = 0.30–0.87, p = 0.01) and travel time to FP (OR = 0.66, 95% CI = 0.47–0.93, p = 0.02) negatively associated with having a scheduled/planned FP appointment. Number of OPCC visits was not associated with either outcome. Conclusion Most patients had not seen an FP for palliative care. Accessibility, availability, and equity are important factors to consider when planning interventions to encourage and facilitate access to FPs for palliative care.

Objective Early palliative care (EPC) in the outpatient setting improves quality of life for patients with advanced cancer, but its impact on quality of dying and death (QODD) and on quality of life at the end of life (QOL-EOL) has not been examined. Our study investigated the impact of EPC on patients’ QODD and QOL-EOL and the moderating role of receiving inpatient or home palliative care. Method Bereaved family caregivers who had provided care for patients participating in a cluster-randomised trial of EPC completed a validated QODD scale and indicated whether patients had received additional home palliative care or care in an inpatient palliative care unit (PCU). We examined the effects of EPC, inpatient or home palliative care, and their interactions on the QODD total score and on QOL-EOL (last 7 days of life). Results A total of 157 caregivers participated. Receipt of EPC showed no association with QODD total score. However, when additional palliative care was included in the model, intervention patients demonstrated better QOL-EOL than controls (p=0.02). Further, the intervention by PCU interaction was significant (p=0.02): those receiving both EPC and palliative care in a PCU had better QOL-EOL than those receiving only palliative care in a PCU (mean difference=27.10, p=0.002) or only EPC (mean difference=20.59, p=0.02). Conclusion Although there was no association with QODD, EPC was associated with improved QOL-EOL, particularly for those who also received inpatient care in a PCU. This suggests a long-term benefit from early interdisciplinary palliative care on care throughout the illness. Trial registration number ClinicalTrials.gov Registry (#NCT01248624).

Objectives The Clinical Evaluation Questionnaire (CEQ) is a patient-reported experience measure (PREM) that assesses the perceived benefit of therapeutic interactions of patients with advanced cancer with their healthcare providers concerning issues relevant to their illness. It was developed for a randomised controlled trial of Managing Cancer and Living Meaningfully (CALM), a brief supportive-expressive therapy for patients with advanced cancer. The present study evaluates the preliminary psychometric properties of the CEQ. Method Patients in the CALM and usual care groups completed the CEQ 3 (n=195) and 6 (n=186) months after randomisation. The CEQ’s internal consistency, factor structure and concurrent validity were evaluated, and CEQ scores in the treatment groups were compared. Results The CEQ demonstrated high internal consistency for both treatment arms (Cronbach’s α=0.94 to 0.95), and a single factor was consistently found in exploratory factor analyses. CEQ scores correlated significantly with satisfaction with the relationship with healthcare providers (r=0.23 to 0.61, p≤0.02) and life completion (r=0.24 to 0.37, p≤0.02) in both groups and with spiritual well-being in the CALM group (meaning: r=0.23 to 0.24, p=0.01 to 0.02; faith: r=0.24 to 0.34, p=0.001 to 0.02). The CALM group showed higher CEQ total scores than usual care at 6 months (CALM: 18.19±6.59; usual care: 14.36±7.67, p<0.001). Conclusions The CEQ is a reliable and valid PREM of the benefit perceived by patients with advanced cancer from their interactions with healthcare providers. Further study is needed to establish its value as a measure of perceived intervention benefit across different clinical and research settings.

OBJECTIVES:Provider-only, combined surgical, and medical multidisciplinary rounds ("surgical rounds") are essential to achieve optimal outcomes in large pediatric cardiac ICUs. Lean methodology was applied with the aims of identifying areas of waste and nonvalue-added work within the surgical rounds process. Thereby, the goals were to improve rounding efficiency and reduce rounding duration while not sacrificing critical patient care discussion nor delaying bedside rounds or surgical start times.DESIGN:Single-center improvement science study with observational and interventional phases from February 2, 2021, to July 31, 2021.SETTING:Tertiary pediatric cardiac ICU.PARTICIPANTS:Cardiothoracic surgery and cardiac intensive care team members participating in daily "surgical" rounds.INTERVENTIONS:Implementation of technology automation, creation of work instructions, standardization of patient presentation content and order, provider training, and novel role assignment.MEASUREMENTS AND MAIN RESULTS:Sixty-one multidisciplinary rounds were observed (30 pre, 31 postintervention). During the preintervention period, identified inefficiencies included prolonged preparation time, redundant work, presentation variability and extraneous information, and frequent provider transitions. Application of targeted interventions resulted in a 26% decrease in indexed rounds duration (2.42 vs 1.8 min; p = 0.0003), 50% decrease in indexed rounds preparation time (0.53 vs 0.27 min; p < 0.0001), and 66% decrease in transition time between patients (0.09 vs 0.03 min; p < 0.0001). The number of presenting provider changes also decreased (9 vs 4; p < 0.0001). Indexed discussion duration did not change (1 vs 0.98 min; p = 0.08) nor did balancing measures (bedside rounds and surgical start times) change (8.5 vs 9 min; p = 0.89 and 38 vs 22 min; p = 0.09).CONCLUSIONS:Lean methodology can be effectively applied to multidisciplinary rounds in a joint cardiothoracic surgery/cardiac intensive care setting to decrease waste and inefficiency. Interventions resulted in decreased preparation time, transition time, presenting provider changes, total rounds duration indexed to patient census, and anecdotal improvements in provider satisfaction.

OBJECTIVES:Death anxiety (DA), a condition characterized by fear, angst, or panic related to the awareness of one's own death, is commonly observed in advanced cancer patients. The aim of this study was to examine the psychometric properties of the Italian version of the Death and Dying Distress Scale (DADDS-IT) in a sample of patients with advanced cancer.METHODS:The sample included 200 Italian advanced cancer patients meeting eligibility criteria to access palliative care. Patients' levels of DA were assessed by using the DADDS-IT, while the levels of depression, anxiety, demoralization, spiritual well-being, and symptom burden were assessed using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Demoralization Scale, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale, and the Edmonton Symptom Assessment System, respectively; Karnofsky Performance Status was used to measure functional impairment. Confirmatory factor analyses (CFA) of previous structures and exploratory factor analyses (EFA) were conducted.RESULTS:CFA revealed that none of the previous structures adequately fitted data from our sample. EFA revealed a 4-factor model comprising Finitude (α = 0.91), Regret (α = 0.86), Dying (α = 0.88), and Relational Burden (α = 0.73), accounting for the 77.1% of the variance. Dying subscore was higher in hospice patients than in those recruited in medical wards.SIGNIFICANCE OF RESULTS:The present study provides further evidence that DA is a condition that deserves attention and that DADDS-IT shows good psychometric properties to support its use in research and clinical settings.

Background:The use of peritoneal catheters for prophylactic dialysis or drainage to prevent fluid overload after neonatal cardiac surgery is common in some centres; however, the multi-centre variability and details of peritoneal catheter use are not well described. Methods:Twenty-two-centre NEonatal and Pediatric Heart Renal Outcomes Network (NEPHRON) study to describe multi-centre peritoneal catheter use after STAT category 3-5 neonatal cardiac surgery using cardiopulmonary bypass. Patient characteristics and acute kidney injury/fluid outcomes for six post-operative days are described among three cohorts: peritoneal catheter with dialysis, peritoneal catheter with passive drainage, and no peritoneal catheter. Results:Of 1490 neonates, 471 (32%) had an intraoperative peritoneal catheter placed; 177 (12%) received prophylactic dialysis and 294 (20%) received passive drainage. Sixteen (73%) centres used peritoneal catheter at some frequency, including six centres in >50% of neonates. Four centres utilised prophylactic peritoneal dialysis. Time to post-operative dialysis initiation was 3 hours [1, 5] with the duration of 56 hours [37, 90]; passive drainage cohort drained for 92 hours [64, 163]. Peritoneal catheter were more common among patients receiving pre-operative mechanical ventilation, single ventricle physiology, and higher complexity surgery. There was no association with adverse events. Serum creatinine and daily fluid balance were not clinically different on any post-operative day. Mortality was similar. Conclusions:In neonates undergoing complex cardiac surgery, peritoneal catheter use is not rare, with substantial variability among centres. Peritoneal catheters are used more commonly with higher surgical complexity. Adverse event rates, including mortality, are not different with peritoneal catheter use. Fluid overload and creatinine-based acute kidney injury rates are not different in peritoneal catheter cohorts.

Evaluate the association of postoperative day (POD) 2 weight-based fluid balance (FB-W) > 10

OBJECTIVES: To evaluate the association between postoperative cumulative fluid balance (FB) and development of chylothorax in neonates after cardiac surgery. DESIGN: Multicenter, retrospective cohort identified within the Neonatal and Pediatric Heart and Renal Outcomes Network (NEPHRON) Registry. SETTING: Twenty-two hospitals were involved with NEPHRON, from September 2015 to January 2018. PATIENTS: Neonates (< 30 d old) undergoing index cardiac operation with or without cardiopulmonary bypass (CPB) entered into the NEPHRON Registry. Postoperative chylothorax was defined in the Pediatric Cardiac Critical Care Consortium as lymphatic fluid in the pleural space secondary to a leak from the thoracic duct or its branches. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 2240 NEPHRON patients, 4% ( n = 89) were treated for chylothorax during postoperative day (POD) 2–21. Median (interquartile range [IQR]) time to diagnosis was 8 (IQR 6, 12) days. Of patients treated for chylothorax, 81 of 89 (91%) had CPB and 68 of 89 (76%) had Society of Thoracic Surgeons–European Association for Cardiothoracic Surgery Congenital Heart Surgery 4–5 operations. On bivariate analysis, chylothorax patients had higher POD 1 FB (3.2 vs. 1.1%, p = 0.014), higher cumulative POD 2 FB (1.5 vs. –1.5%, p < 0.001), achieved negative daily FB by POD 1 less often (69% vs. 79%, p = 0.039), and had lower POD 1 urine output (1.9 vs. 3. 2 mL/kg/day, p ≤ 0.001) than those without chylothorax. We failed to identify an association between presence or absence of chylothorax and peak FB (5.2 vs. 4.9%, p = 0.9). Multivariable analysis shows that higher cumulative FB on POD 2 was associated with greater odds (odds ratio [OR], 95% CI) of chylothorax development (OR 1.5 [95% CI, 1.1–2.2]). Further multivariable analysis shows that chylothorax was independently associated with greater odds of longer durations of mechanical ventilation (OR 5.5 [95% CI, 3.7–8.0]), respiratory support (OR 4.3 [95% CI, 2.9–6.2]), use of inotropic support (OR 2.9 [95% CI, 2.0–4.3]), and longer hospital length of stay (OR 3.7 [95% CI, 2.5–5.4]). CONCLUSIONS: Chylothorax after neonatal cardiac surgery for congenital heart disease (CHD) is independently associated with greater odds of longer duration of cardiorespiratory support and hospitalization. Higher early (POD 2) cumulative FB is associated with greater odds of chylothorax. Contemporary, prospective studies are needed to assess whether early fluid mitigation strategies decrease postoperative chylothorax development.