When Nash Keen was born on July 5, 2024, at just 21 weeks' gestation, he had to be resuscitated.
No baby had ever survived after being born so early. In fact, Nash’s mother, Mollie Keen, said it was too early for any hospital in Des Moines — 22 weeks being the earliest any hospital in the area could deliver a baby. So, the Ankeny family looked for other options.
“One of my really good friends helped put me in some support groups for incompetent cervix, and we posted my situation,” Keen said. “And a former NICU mom, who happened to be at the University of Iowa at that time with her premature daughter, had said Iowa City is doing life-saving measures on 21-weekers.”
"It’s really a joy to see how far he’s come."Mollie Keen, Nash's mother
Keen had been diagnosed with an incompetent cervix, meaning her cervix would shorten and dilate prematurely, and after a previous miscarriage, she had a preventative stitch put in to try to keep Nash to full term.
When she started having contractions at the end of her 20th week, a friend rushed Keen to the University of Iowa’s Stead Family Children’s Hospital in Iowa City. There, she had to get her preventative stitch removed to prevent damaging her cervix.
“At that time, we pretty much said goodbye to Nash, because we thought for sure that he would come out as soon as that stitch was taken out,” she recalled.
In fact, no other baby had ever survived being born at just 21 weeks’ gestation.
“I was incredibly blunt with her [Keen] and [Nash’s] Dad,” said Patrick McNamara, the director of neonatology at the hospital and one of Keen’s doctors. “I told them the survival chance was zero, because no one had ever survived at 21-plus-zero. So, by the laws of life, there has not been a survivor. However, we would do everything we could in our power to change that paradigm.”
Keen delivered her baby, and Nash had to be resuscitated and was immediately intubated.
“I was able to get our smallest breathing tube in Nash, and he responded very nicely to that,” said Amy Sanford, another doctor that helped Keen deliver her son. “His heart rate stabilized, his oxygen levels stabilized, and so Nash was showing us that he was strong enough to have a fighting chance.”
More than half a year in the hospital
Nash spent 189 days in the hospital. He was diagnosed with chronic pulmonary hypertension — which occurs due to abnormal blood vessel growth in the lungs — and mild permanent hearing loss.
But Nash's doctors credit new and advanced ultrasound technology with helping them identify his diagnoses, along with the use of neonatal hemodynamics.
“Hemodynamics is the use of advanced echocardiography or ultrasound of the heart to better characterize issues with heart function, elevated pressures in the lung, or issues of blood supply to the lung or the heart,” McNamara said. “The field did not exist until I started building it at Sick Kids [the Hospital for Sick Children] in Toronto around 2006-2007.”
The University of Iowa now has the largest neonatal hemodynamic program in the world.
“People come from all across the world to learn how we take care of extremely preterm babies and how we use hemodynamics to provide better information to understand what’s going wrong with these babies,” McNamara said.
Nash’s survival signifies the opening of a new frontier in the industry’s ability to support premature babies.
“What we have learned, and not just necessarily with Nash, is that survival is possible at 21 weeks’ gestation, but not just survival — meaningful survival,” McNamara said.
Now, just over 1 year old, Nash has been given the Guinness World Record for most premature baby at 21 weeks and zero days. The title was previously held by Curtis Means, who was born at 21 weeks and 1 day.
“When we discovered that Nash was 21 [weeks] and zero [days], we were like, ‘holy crap,’” Keen said.
She said she still takes Nash to the hospital for appointments, but the amount of oxygen he needs is going down, and Keen suspects that he will be able to come off oxygen soon.
“He’s so full of personality,” Keen said. “He’s happy. He kicks his legs all the time. He might be a little delayed in some milestones, but I expect him, by maybe 2 or even just before Kindergarten, that he’ll be right alongside his peers. It’s really a joy to see how far he’s come."
