World’s most premature twins are now happy at three

Identical twins Kambry and Keeley Ewoldt (USA) have defied odds since their very first breath.

The tiny twins, born at the University of Iowa Hospitals & Clinics in Iowa City, Iowa, USA on November 24, 2018, hold the world record most premature twins.

But unlike many record accomplishments, this was not a record title the Ewoldt family voluntarily sought.



Originally scheduled for March 29, 2019, the twins unexpectedly arrived 125 days early. When they entered the world at a mere gestational age of 22 weeks 1 day, or 155 days, the cards were already stacked against them.

“It was about 24 hours after my water broke that I delivered the girls,” said the twins’ mother, Jade Ewoldt.

“The risks I knew were there of losing them were high, so I fully prepared for what was to come next.”

Keeley (Twin A) weighed 490 grams (1 pound 1.3 ounces) and Kambry (Twin B) weighed 449 grams (15.8 ounces).


“I was 16 weeks pregnant when I went to one of my doctor’s appointments and found the girls had twin transfusion syndrome,” Jade said.


Twin-to-twin transfusion syndrome (TTTS) is a serious disorder that occurs in identical twins and higher-order multiples who share a placenta.

When the blood vessels in babies’ shared placenta are connected, one baby (the recipient) receives more blood flow, while the other baby (the donor) receives too little.

“Essentially what happens in TTTS is both babies getting sick,” Jade said.


“A baby gets smaller and sicker while a baby gets bigger and sicker. This can actually lead to the death of one or both twins.”


Luckily for the little ladies, University of Iowa hospitals and clinics have a Level IV NICU, the highest level of neonatal care.

“Normal pregnancy is up to 40 weeks. Most places in the United States and around the world believe that babies born before 24 weeks gestation really have a slim chance of surviving,” said Dr. Jonathan M. Klein , neonatologist and medical director of the NICU. at the University of Iowa Stead Family Children’s Hospital.

“At the University of Iowa, since 2006, we have been caring for babies born as early as 22 weeks, which is 18 weeks before their due date, with great success.”

At 22 weeks gestation, a baby’s eyelids are still closed and their nervous system is developing and heightening their senses.

Even before they were born, Jade knew their outlook was bleak and the possibility of her daughters surviving was very low.

“I have already been given what the future may hold for them,” she said.


“Things like cerebral palsy, autism and severe disabilities are things they need to share with you as parents so you can make the best choice for you and your family.”

Although medical professionals knew that Ewoldt’s preemies would face a long road to recovery, they remained hopeful.

“When caring for babies who are in a perishable state, it’s important not to label them as an extremely premature baby who has no chance of survival,” Dr. Klein said.

“We consider a 22-week-old baby to be a critically ill adult. We expect these babies to survive, we expect them to be well, we expect them to thrive.” – Dr. Jonathan M. Klein, NICU medical director at Stead Family Children’s Hospital, University of Iowa

Stead Family Children’s Hospital neonatologist Dr. Timothy G. Elgin said their team of neonatal healthcare professionals had prepared for the arrival of the twins.

Two different resuscitation teams consisting of neonatal nurses, a neonatal companion and a neonatal transport team were present during their birth to give each twin close attention.


“When one was born, we were able to intubate, put on a breathing tube, make sure he had the right heart rate and was at the right temperature before bringing him back to the NICU,” said the Dr Elgin.

Jade recalls the moving day her miracle duo was welcomed into the world.

“Immediately after Keeley was born, the NICU team was already in the room prepped and ready. She was in such critical condition that they had to take her straight to the NICU,” he said. she declared.

“And as she left the room and I said goodbye to her, Kambry was born. She was revived and taken to NICU.”


For the next five months, Jade split her life between her two oldest children at home, Koy and Kollins, and Stead Family Children’s Hospital.

Until the day her children were discharged from the hospital, she made a two-hour round trip almost every day to spend time with them.

But the girls’ struggles didn’t end once they left the hospital.

“When Keeley and Kambry first came home from NICU in 2019, they were diagnosed with chronic lung disease and severe borderline disorder (bronchopulmonary dysplasia). oxygen in our house and started with cords and tubing around our house,” Jade said.


“We no longer had the support of NICU staff. The very first day was really scary.”

Although older literature suggests that babies born very early tend to be neurologically devastated, Dr. Klein mentioned that developing neuroprotective strategies and protecting their brains often leads to good outcomes.

“When we follow our babies born at 22 weeks, more than two-thirds of them are completely normal, with very mild disabilities,” he said.

Like any mother would, Jade did her best and adapted her life to ensure her daughters had what they needed to grow strong.


Today, the Ewoldt sisters have grown into tough twins and are as happy as any other toddler.

“It’s really interesting that they’re identical twins, and most would say even at this age they don’t have noticeable differences, but they do. They’re completely different individuals,” Jade said.

“Keeley is very girly, and she’s scared of even a fuzzy toy. She’s just very delicate.”

Kambry, who lives with autism, brings as much happiness and positivity to her family as her “big” sister.

“We love her because those traits are who she is. She’s fearless. There’s no stopping this girl. She’s just the ham of the room.”


The toddlers started speaking a year and a half ago and although Kambry is largely non-verbal, the Ewoldts began teaching him sign language, which they still use today, for communication. help express themselves.

“It was comforting for her to use sign language, rather than trying to use words. We were very lucky to have different things in place for them to learn individually,” said Jade.

“They’re going to kindergarten this fall and I honestly think they’re going to be advanced for their grade.”

As their fourth anniversary approaches in November, Jade looks back on the past three and a half years with admiration for the strength and resilience of Keeley and Kambry.


“They’ve done so much, and they’ve done more than they even realize. I know if they can do all these crazy things, then I can definitely do anything alongside them,” she said. declared.

“It really tested my faith, but it made me stronger. You learn to appreciate life on simple levels that most people never experience in their life.”

Jade now leads a non-profit organization, Keeley & Kambry’s Tribe, which advocates changing fetal viability.