At 21 weeks gestation, a baby’s vital organs—the brain, heart, and lungs—are still developing.
Just after midnight, July 5, 2024, Nash Keen was born at the University of Iowa Health Care Stead Family Children’s Hospital. Arriving 133 days early, weighing only 10 ounces and defying all odds.
Ankeny’s Nash Keen, who just celebrated his first birthday, now holds the Guinness World Record title holder as the “most premature baby.”
Most hospitals don’t offer resuscitation until babies are 22 weeks’ gestation. The University of Iowa Health Care Stead Family Children’s Hospital does—and on a “case-by-case basis,” 21 weeks.
“Previously at the University of Iowa, we had not offered resuscitation until babies were 22 weeks’ gestation,” said neonatologist Amy Stanford, MD. “Over the last several years, our outcomes at 22 weeks are fantastic, and we have families asking us to try at 21 weeks…we offer what we call a ‘trial of life,’ because at 21 weeks, sometimes the babies are just too small for our smallest equipment.”
A long journey to parenthood
For the Ankeny-based family, Mollie and Randall Keen, the choice was obvious. Six months before getting pregnant with Nash Keen, the couple lost their daughter, McKinley Keen, at 18 weeks gestation.
Mollie Keen has polycystic ovary syndrome (PCOS), a disorder that can make it harder to get pregnant. After losing McKinley, she was diagnosed with an “incompetent cervix,” a condition that causes the uterus to weaken and open too soon during pregnancy, often leading to preterm birth.
The couple saw their dreams of starting a family start to dwindle. Then came Nash.
That’s when history started to repeat itself. Mollie visited the doctor for her 20-week scan when doctors noticed something alarming, but familiar to the hopeful mom.
“They found I was already two centimeters dilated,” Mollie Keen said in a news release. “We were devastated. We thought we were going through the exact same thing, and we thought we were going to lose this baby.”
Mollie Keen started having contractions two days later and was put on bedrest. But when “heavy contractions” woke her at 2 a.m., the Keen family rushed to Iowa City.
“At that point, I didn’t know what I could do to turn things around,” Mollie Keen said.
The race to Iowa City
Doctors delayed Mollie’s labor for two days. Just hours after passing the 21-week mark, her intuition kicked in.
“I just remember feeling a bit off,” Mollie Keen said. “I had them check to see how dilated I was, and maybe a second later, I had a bunch of people in my room.”
The team of doctors and nurses delivered Nash successfully, then handed to the NICU (Neonatal Intensive Care Unit). They were preparing for the worst.
“We all felt a rush of relief when we were able to get the breathing tube in because that meant that we could keep going,” said Stanford. “We quoted (that Nash) had a zero chance of survival, because before him, no one had survived that young.”
A groundbreaking team approach and neonatal hemodynamics
The first day of Nash’s life was a “flurry of activity.” The NICU team worked to get IVs in his belly button, strategized ventilator support, and his blood flow was monitored by neonatal hemodynamics.
Hemodynamics is the study of blood flow through the circulatory system, or “the mechanic for the heart,” according to Patrick McNamara, MD, division director of neonatology at Stead Family Children’s Hospital.
“Hemodynamics is the use of ultrasound to better understand how well the heart is working and how adequate the blood supply is to key organs,” McNamara said. “(Without it) it is like a person who has got no training trying to fix a car, randomly changing parts in an engine and hoping that things work.”
The University of Iowa has revolutionized hemodynamics in neonatal care. Dr. Stanford is the second physician to complete Iowa’s hemodynamics fellowship, a first of its kind in the United States.
Hemodynamics allowed doctors to fine-tune care and maintain consistency, cutting the risk of death or severe brain bleeding in half, while stimulating a womb-like environment necessary for development.
More than a Guinness World Record
The first few weeks of Nash’s life were hard, interrupted by regular blood draws, medications, frequent scans, and surgery for a perforated bowel.
Doctors “began to breathe a little easier” at the one-month mark and felt “confident that he had a real chance of going home.”
Nash Keen was cleared to go home after 189 days in the hospital, heading to Ankeny in January 2025.
Nash Keen, now 1, is doing “remarkably well” and is a happy and giggly baby.
The Keen family and doctors hope that by the time Nash is in kindergarten, “no one will know that he was born so early,” Stanford said.
“(Nash Keen’s story) is so much more than a Guinness World Record. It’s proves that impossible things that can be done,” Stanford said. “(When) we work together and learn from every patient, we keep pushing boundaries and seeing what’s attainable.”
Mollie and Randall Keen hope their son’s story inspires him, knowing people have cheered him on since the beginning.
“Nash isn’t just a record breaker – he’s a heart-stealer,” Mollie Keen said. “From the very beginning, our family and friends rallied behind him, and as his story spread, so did the love.”
(This article has been updated because an earlier version included inaccuracies.)
Jessica Rish is an entertainment, dining and education reporter for the Iowa City Press-Citizen. She can be reached at JRish@press-citizen.com or on X, formerly known as Twitter, @rishjessica_
This article originally appeared on Iowa City Press-Citizen: Teeny and unstoppable, meet the Iowa baby born at record 21 weeks thriving a year later
Reporting by Jessica Rish, Iowa City Press-Citizen / Iowa City Press-Citizen
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