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University of Iowa preemie breaks world record after surviving birth at 21 weeks
‘We’re the best in the world’
Jul. 23, 2025 5:55 pm, Updated: Jul. 24, 2025 7:36 am
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IOWA CITY — Driving home from her 20-week ultrasound last summer, Mollie Keen felt in her gut the fear that only a woman who has lost a child would know.
“I just bawled because I felt like we were about to go through the same situation that we did with our daughter,” Mollie, 34, said about baby McKinley, who she and her husband Randall lost in 2023 at just 18 weeks’ gestation.
Earlier that day, the Ankeny couple — pregnant again — had gone in for their 20-week ultrasound and learned they were having a boy. But after the scan, not feeling quite right, Mollie asked a doctor to take a closer look.
“And they ended up telling me that I was two centimeters dilated,” she said.
Just half way through the typical 40-week term, Mollie — diagnosed after her miscarriage with an incompetent cervix — said the doctors didn’t have a lot of advice.
“They pretty much just told me to go home and try to keep baby in as long as possible,” she said. “So I went home.”
But she ended up in the ER that evening, feeling more pressure, and was placed on bed rest. It was in that helpless state that a friend connected her with an online support group for others with an incompetent cervix — a condition where the cervix begins to shorten and dilate prematurely.
Given the condition can lead to premature birth, Mollie shared her story in search of advice and hope — and one woman offered it via University of Iowa Health Care, just two hours up Interstate-80.
“A former NICU mom, who happened to be at the University of Iowa at that time with her premature daughter, said, ‘Hey, Iowa City is doing lifesaving measures on 21-weekers. If you're anywhere near University of Iowa, get up here. They're fantastic.”
‘Best in the world’
Although most studies measuring premature-baby outcomes start at 22 and 23 weeks — reporting U.S. survival rates between 10 and 20 percent at that gestation — UIHC is among the few hospital systems that take on babies at 21 weeks.
The UI Stead Family Children’s Hospital now has cared for more than 20 babies born in the 21st week, with seven surviving, Patrick McNamara, director of the UIHC Division of Neonatology, told reporters Wednesday.
For babies born at 22 weeks over the last 10 years, the UIHC survival rate jumps to 65 percent.
“We’re the best in the world,” McNamara said.
And now it holds the Guinness World Record for most premature baby too — after Mollie and Randall showed up unannounced in the middle of the night a year ago.
“They had no idea that I was even coming,” she said. “I just checked into the labor and delivery area of the hospital, and they got us a room pretty quickly actually.”
Only days away from the 21-week mark, now admitted at UIHC, Mollie’s water broke. But she managed to hang on until the morning of July 5 — breaking 21 weeks exactly — when a full team rushed to her bedside to deliver her son.
Nash Keen was born July 5, 2024.
“Once he was out, we were really focused on Mom,” UIHC high-risk obstetrician Malinda Schaefer said. “We try to manage and decrease any blood loss or prevent any hemorrhage."
Handing Nash off to the NICU team, neonatologist Amy Stanford rushed to answer the key question facing all preemies born at the university.
“Are they big enough for our smallest equipment?”
Could Stanford thread tiny breathing tubes into the tiny lungs of a 10-ounce Nash?
“That responsibility fell to me, and I was able to get our smallest breathing tube in Nash,” she said. “And he responded very, very nicely to that. His heart rate stabilized. His oxygen levels stabilized.
“Nash was showing us that he was strong enough to have a fighting chance.”
‘So resilient’
With every week that ticked by, Nash’s chance at long-term survival increased, according to McNamara — who said the odds, statistically speaking, started at zero.
“Mollie will remember the day, I was incredibly blunt and direct with her and Dad, I told them the survival chance was zero,” he said. “Because no one had ever survived at 21 (weeks) and zero (days). So by the laws of life, there had not been a survivor.
“However, we would do everything we could in our power to change that paradigm.”
The previous preemie record was held by a baby born in Alabama in 2021 at 21 weeks and one day. And despite his record-setting birthday, Nash is far from the lightest surviving baby — with that title still held by an infant born in 2020 in Singapore at 7.5 ounces, according to “The Tiniest Babies” registry.
“Getting through that first day is the first step,” McNamara said. “Getting through that first week is an even greater step. And as time goes on, the likelihood of survival — particularly if the baby has had very few complications — increases.”
And Nash — thanks to the UI care team and its use of “hemodynamics” — escaped major complications. Although his vital signs dipped at times and he has chronic pulmonary hypertension and a minor heart defect that doctors expect will resolve over time, Nash didn’t experience any brain bleeds — common in extremely premature infants — likely due to the hemodynamics protocol.
“It allows for us to really fine tune and tailor our therapies,” Stanford said about the technique that uses ultrasound to precisely assess blood flow and heart function, allowing for targeted treatment at any sign of trouble.
Stanford is the second physician to complete Iowa’s hemodynamics fellowship program — the first of its kind in the nation — focused on training neonatologists to use hemodynamic care.
“For Nash, when he was first born his blood pressure was really low,” she said. “At first, you might think that means his heart was struggling, but with hemodynamics we were able to check and see that the heart was functioning well, so we adjusted our approach from there.”
After 189 days — spending Thanksgiving and Christmas with the UIHC care team they remain in touch with today — the Keen family in January headed home.
And while Nash has needed other surgeries and monitoring, the hope is he’ll be your typical backpack-toting kindergartner when he starts school in a few years.
“If I could describe Nash, it would be him, with his hands behind his head and his feet crossed, kicking back, like, what's next?” Mollie said. “Nothing fazed him, and it still doesn't.
“He's just so resilient.”
Vanessa Miller covers higher education for The Gazette.
Comments: (319) 339-3158; vanessa.miller@thegazette.com
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