DYSART, Iowa — Identical twin girls Kambry and Keeley Ewoldt are young but already setting records.
Swaddled and warm in an Iowa City neonatal intensive care unit, the tiny infants are the most premature surviving twins born at University of Iowa Hospitals and Clinics.
Keeley James and Kambry Lee arrived 18 weeks early on Nov. 24, delivered at 22 weeks and one day gestation, the Waterloo-Cedar Falls Courier reported.
“They would be clearly among the top four or five earliest babies ever delivered here. We had one at 22 (weeks) and zero (days) and another at 22 and one, but neither were twins,” said Dr. Jonathan Klein, a neonatologist and medical director of the NICU at University of Iowa Stead Family Children’s Hospital.
At birth, Keeley weighed 1 pound and Kambry weighed 13.4 ounces. Each baby was about the length of a dollar bill.
“I’d never heard of babies being born this early,” Wesley Ewoldt, 29, said. “We didn’t have a lot of positive thoughts. They told us from the get-go this is going to be a roller-coaster ride.”
Late last summer, parents Jade and Wesley Ewoldt of Dysart were elated to find out they were expecting twins. Their family of four — including daughter Kollins, 3, and son Koy, 5 — would expand to six.
Jade Ewoldt’s pregnancy was smooth until 16 weeks gestation when the babies were diagnosed with twin-twin transfusion syndrome. TTTS is the abnormal formation of blood vessel connections between identical twins sharing a placenta. Those connections create uneven blood flow between the babies and can be fatal for both twins.
“(TTTS) is also very rare,” Klein said. “A lot of patients pass away before they are even born.”
At 17 weeks gestation, the twins underwent surgery in utero at Cincinnati Children’s Hospital to seal and disconnect the aberrant vessels. TTTS, even when treated successfully, often causes premature birth. That’s what happened with the Ewoldt twins.
Four weeks after the surgery, on Nov. 23, Jade’s water broke at home. She was exactly 22 weeks along.
“I was so mad and upset and scared,” she said. “I was just praying the girls wouldn’t be born at home.”
The 1-hour, 15-minute ambulance ride to UIHC felt like one of the longest rides of her life, Jade Ewoldt, 28, said. The ambulance crew told her if the babies were born along the way, they weren’t equipped to save them.
“I must’ve asked them a thousand times if we were there yet,” she said.
UI Stead Family Children’s Hospital is home to Iowa’s only Level 4 NICU — the highest level recognized by the American Academy of Pediatrics. It is among 22 percent of U.S. hospitals that provide active care for infants born at 22 weeks gestation.
In 2016 in the United States, 1,857 babies were born alive at 22 weeks, Klein said. There were nearly 4 million live births.
“For 22-week babies to survive, it’s incredibly rare,” he said. “Nationally, survival is around 10 percent. Here at (UIHC), our survival rate over the last 10 years is 65 percent, 650 percent higher than the national average.
“Many places consider babies less than 24 weeks incapable of survival. But we know it’s possible. And it’s one of those things we are now getting more recognition for nationally.”
Klein said it’s a huge team effort, from surgeons to obstetricians to neonatologists to nurses, to keep alive babies who are born so early.
Skin is so fragile it can tear under the gentlest touch. Eyelids are not yet formed. Respirators delivering the smallest puffs of air keep the girls breathing. A neuroprotective strategy developed by UIHC doctors for premature babies limits and monitors stimulation — such as light, sound and touch — to keep the babies’ stress levels low and limit swings in blood pressure.
“It’s overwhelming when you think about these things,” Jade Ewoldt said. “So much goes into making sure these two little girls stay alive.”
Kambry lost some weight after she was born, which is common among preemies. Her lowest recorded weight is 11.64 ounces — less than a can of soda.
Keeley had surgery to close a vessel that’s only necessary in utero and, left intact after birth, can cause heart failure.
“Our babies, at the time of surgery, are smaller than most adult hearts. It’s mind-boggling to think they are doing surgery around hearts the size of thumbnails,” Klein said.
Jade Ewoldt stays at the twins’ NICU bedsides most days, returning home a couple of days a week to spend time with her husband and other children. Family and friends help shuttle Koy and Kollins to and from school and activities, and babysit while Wesley goes to work.
It’s been that way for 57 days, and will be for many more. The earliest the twins will go home is their original due date — March 29. They’ll be 4 months old.
The Ewoldts said they aren’t yet thinking about long-term prognoses for Keeley and Kambry. For now, the girls are growing and progressing. Earlier this month, Keeley weighed 3.1 pounds, and Kambry weighed in at 2.1 pounds.
Through faith, though, the parents remain hopeful.
“You just think of what they can be,” Wesley Ewoldt said.
Statistics from the hospital’s NICU are on their side.
“We’ve followed up on many of these babies over the years,” Klein said. “The good news is, based on our neuroprotective care strategies, only 10 percent born at (UIHC) have long-term disability — blindness, deafness, cognitive disabilities.”
Klein said the probability and severity of long-term disabilities in premature babies can be predicted based on problems present at birth or shortly after, such as bleeding in the brain.
“In these girls, we’ve not seen that. The odds are in their favor.”