Iowa baby, born at 21 weeks, holds world record as the most premature

An Iowa family recently celebrated a major milestone for a very special baby.

Mollie and Randall Keen welcomed their son, Nash Keen, on July 5, 2024. He was born 133 days early, at just 21 weeks gestation.

Guinness World Records has officially recognized Nash as the world’s most premature baby to survive.

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Earlier this month, Nash — affectionately nicknamed “Nash Potato” — turned 1 year old, defying all odds. 

When he was born at the University of Iowa Health Care Stead Family Children’s Hospital, Nash weighed just 285 grams (10 ounces) at birth — less than a grapefruit — and measured 24 centimeters long, according to a press release from the hospital.

Two years before Nash’s premature birth, the Keens lost a baby girl, McKinley, at 18 weeks gestation.

At that time, Mollie Keen was diagnosed with an incompetent cervix, which is when the lower part of the cervix begins to open (dilate) too early, typically in the second trimester, the release shared.

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She also suffers from polycystic ovary syndrome (PCOS), a hormonal disorder that can cause fertility difficulties.

Six months after their loss, the Keens found out another baby was on the way.

“When we went to our local doctor’s office for the 20-week scan for Nash, I just had some concerns about how I was feeling, so I asked them to look at me closer — which they normally don’t do at that appointment — and they found I was already 2 centimeters dilated,” Mollie Keen said.

A few days later, she began having contractions and was placed on bed rest.

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“We were devastated,” she said. “We thought we were going through the exact same thing — we thought we were going to lose this baby.”

The medical team at Stead Family Children’s Hospital’s neonatal intensive care unit (NICU) provides life-saving care for babies born at 21 weeks gestation and later.

Fortunately, Mollie’s care team was able to delay labor until just 10 hours after Nash surpassed the 21-week mark.

“We want what is best for patients, so we really try to convey that we do not know what the outcomes will be for these extremely premature births,” said Malinda Schaefer, M.D., Ph.D., the high-risk obstetrician who delivered Nash.

“It is important for parents to understand most survival rates are low, and if babies do survive, they have a very high risk of long-term complications, even at 22 weeks.”

The team quickly provided medicine to Nash to support his organ development and to reduce the risk of complications, according to the release.

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“Sometimes babies born at 21 weeks are just too small for even our tiniest breathing tubes and intravenous lines,” said neonatologist Amy Stanford, who treated Nash. “Our NICU team assessed Nash, and I was able to place a breathing tube. Once we had the breathing tube in, his heart rate stabilized and his oxygen levels were good.”

Even so, Nash’s chances were slim, as no baby that young had ever survived.

Before Nash’s birth, the most premature baby to survive was Curtis Zy-Keith Means, born to Michelle Butler on July 5, 2020, at the University of Alabama at Birmingham Hospital, according to Guinness World Records. He was born at a gestational age of 21 weeks and 1 day, which was 132 days premature.

“We never want the parents to lose hope, but many of them are in an unreal situation, so we have to be very honest with them,” said​ Patrick McNamara, M.D., division director of neonatology at Stead Family Children’s Hospital. 

“I would have told his parents, ‘The chance is zero, but I hope I’m wrong, and we will do everything we can to help him.’”

“I want him to see his story as a source of strength.”

Around the one-month mark, Stanford said, the team began to “breathe a little easier.”

“While we knew Nash still had a long journey ahead, that was the point when we started to feel more confident that he had a real chance of going home.”

“It was a subtle but powerful shift – from day-to-day survival to long-term hope.”

Nash received ongoing care during his 198 days in the hospital, as the team monitored his heart function and brain health.

In addition to receiving many medications, he also underwent surgery for a perforated bowel, which has up to a 40% mortality rate.

“They were on top of it every step of the way. They really gave him a fighting chance,” said Randall Keen. “They were really honest with us during the whole journey about what his chances looked like. They made sure we were well-informed and kept us involved in all the decision-making.”

After more than six months in the hospital, Nash was finally able to go home in January 2025.

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He will continue to be monitored for ongoing health issues, including a minor heart defect, and is currently being weaned from oxygen. Nash is still on a feeding tube and wears hearing aids.

Although he has had some developmental delays, Nash is getting stronger and more interactive with the help of ongoing therapy sessions, according to his mother.

Stanford shared her ultimate goal for Nash — “that by the time he’s 5 years old when he goes to kindergarten, no one will know that he was born so early.”

“Nash’s remarkable outcome reflects the progress we’ve made by building on the experiences of those patients who came before him,” she added.

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Mollie Keen shared that she wants Nash to know how loved he is — and “how many people have cheered him on from the very beginning.”

“I want him to grow up and be healthy, happy and confident in who he is. I want him to see his story as a source of strength.”