Guinness World Record’s most premature baby at 21-weeks of gestation celebrates his first birthday

A baby born at only 21 weeks of gestation last July in Iowa City, Iowa, has just celebrated his first birthday, and among his gifts is a Guinness world record for most premature baby.

Nash Keen was born on July 5, 2024 — 133 days earlier than the expected due date and weighing only 10 ounces (283 grams) — about the size of a bar of soap. He spent the next six months in the neonatal intensive care unit at the University of Iowa Health Care Stead Family Children’s Hospital before he was allowed in January to go home to Ankeny, Iowa, with parents Mollie and Randall Keen.

“Nash is so full of personality. He’s a happy baby,” Mollie Keen said Wednesday, adding that he’s slept through most nights since coming home from the NICU. “Being in the NICU as long as he was, you’d think that he would be, you know, more fragile and stuff. And he’s not. He’s a very determined, curious little boy, and he’s just all smiles all the time.”

Nash is among the growing number of extremely premature infants who are getting lifesaving treatment and surviving. Upon reaching his first birthday, Guinness World Records declared Nash the world’s most premature baby, beating out by a single day the organization’s previous record holder born in 2020 in Alabama.

Nash’s parents had already experienced the heartbreak of losing a baby when Mollie’s first pregnancy ended in a miscarriage. That’s when she learned of a medical condition she had that might make it difficult for her to carry to full term.

Mollie worried she and her husband might lose Nash, too, when she learned at her 20-week prenatal checkup that she was already 2 centimeters dilated. Doctors don’t typically try to perform lifesaving measures for babies born before 22 weeks gestation as most born that young can’t survive. But Mollie learned the neonatal team at Stead Family Children’s Hospital was performing lifesaving measures on babies born at 21 weeks gestation. She went into labor days before that benchmark, but with medical help, she was able to stall the birth to exactly 21 weeks.

The next month was fraught with medical scares as an entire team of doctor’s worked to keep Nash alive and thriving.

“One of the things I noticed about the medical team is that they were very calm,” she recalled. “You never really saw them, like, get anxious or anything. And so we kind of just learned to, like, watch them. And if, you know, if the doctors and the nurses weren’t freaking out, there was no reason for us to freak out.”

Dr. Malinda Schaefer, a high-risk obstetrician who delivered Nash just hours after he surpassed the 21-week mark, described his birth as a new frontier in maternal fetal medicine. Still, when consulting with the Keens before the birth, she didn’t sugarcoat Nash’s chances at survival or the likelihood that he would face serious medical complications if he did survive.

“Ultimately, it is not me that lives with the outcomes of parents’ decisions, so it is really important to me to have honest and open conversations with parents, so they feel fully informed to make the best decision for them and their family,” Schaefer said.

While Nash has experienced some complications and developmental delays common to those born extremely prematurely, his progress has been as good as medical science could hope for, his doctors say.

At just over a year old, Nash remains on oxygen to help him breathe and is fed solely through a feeding tube, although he’s preparing to try pureed foods. He also has a minor heart defect, which his doctors believe will resolve itself as he gets older.

He’s not yet crawling, but he is rolling over.

“He’s learning how to stand on his two feet, which is awesome,” his mom said. “He’s got a lot of strength in those legs.”