They were tiny preemies, born at 27 weeks last February, weighing just over 2 pounds each.

The twin girls spent two months in a neonatal intensive care unit, steadily growing enough after their tough start in life to be sent home with their parents.

But four months after they were discharged from the hospital, Samantha and Charlotte Krutina weighed essentially the same as when they left the NICU .

By the time they were admitted to Children’s Hospital & Medical Center on Sept. 1, doctors and law enforcement officials said Samantha and Charlotte Krutina were “severely malnourished.” Samantha actually weighed slightly less than she had in April: 4 pounds, 6.6 ounces in September vs. 4 pounds, 13.3 ounces.

An expert said the girls should have gained 5 pounds in that time.

Samantha arrived at the hospital unresponsive and died the same day; an autopsy later determined that she died of sepsis complicated by severe malnutrition. The hospital staff did not note any underlying medical conditions.

Her twin sister, Charlotte, was diagnosed with rickets, a weakening of the bones that can be caused by malnourishment and lack of vitamin D. It’s a disease that has been largely eradicated in the United States. She weighed 5 pounds, 4.7 ounces .

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Several members of a child advocacy team convened at Children’s Hospital in the wake of Samantha’s death and Charlotte’s hospitalization called it “one of the worst cases of neglect they have encountered,” according to an affidavit filed in Cass County Court.

The girls’ parents, Kassandra A. Krutina, 20, and David J. Krutina Jr., 23, of Louisville, Nebraska, now face felony charges of child abuse in Samantha’s death and Charlotte’s neglect.

Each faces up to 23 years in prison if convicted on both charges. The two were arrested Friday and are free after posting 10 percent of their $10,000 bail amounts.

Attorneys for both did not return calls for comment. A man who identified himself as David Krutina’s grandfather declined to comment on the case.

Charlotte has since been placed with David Krutina’s grandparents and is now thriving, the affidavit said. The couple also have two other children, ages 5 and 1½.

In the arrest affidavit, Sgt. Douglas J. Durkan of the Cass County Sheriff’s Office detailed what he called several red flags: missed doctor appointments, health insurance coverage for the twins that had lapsed, their lack of growth and Kassandra and David Krutina’s behavior after their daughters were admitted to Children’s.

Kassandra Krutina told Durkan that she took the babies to their pediatrician shortly after they were released from the NICU and several times after for checkups and immunizations.

After an initial appointment, David Krutina said they discovered that the babies weren’t covered by his employer’s health insurance. The twins’ birth and hospital stay were covered by Kassandra Krutina’s insurance, but that coverage evidently ended once they were discharged from the NICU.

Because of the insurance problems, they skipped some of the babies’ follow-up visits to the doctor, David Krutina said.

Records from the doctor’s office showed only one visit for Samantha two days after she was released. The parents say Charlotte had two doctor’s visits — one the day after her release and another a few days later. Doctor’s office records also show several canceled or no-show appointments.

Kassandra Krutina said she largely cared for the twins on her own; David Krutina said he spent “90 percent” of his time with his older son. She told Sgt. Durkan that she fed the girls 3 to 3.5 ounces of milk every three hours, round the clock, and kept a careful weekly log of their weight.

She claimed she brought up concerns over their lack of weight gain when she took her two older boys to their doctor. She said he suggested feeding the girls baby food and adding cereal to their bottles.

But Kassandra Krutina said the girls pushed the food out with their tongues “and she wasn’t going to force them to eat it,” Durkan wrote.

The investigator asked her if the stress of being a young mother of four children — including premature twins — may have led her to oversleep and miss feedings.

“I got up in the middle of the night with them; I don’t know why they were losing weight,” she responded.

She told Durkan she had called a nurse’s hotline several times for advice, but Durkan found few calls when he pulled her phone records. She also sent Facebook messages to a NICU nurse. In an interview with law enforcement, the nurse said she was under the impression that the twins were being monitored by a pediatrician.

On Sept. 1, the day of Samantha’s death, David and Kassandra Krutina said the baby was congested and vomited at home. They brought her to Children’s, where medical staff performed CPR for two hours.

Hospital staff then asked the Krutinas to bring in Charlotte, too. A social worker called the Cass County Sheriff’s Office to report the parents. Samantha died later that night.

Staff reported “concerning” behavior: The couple stayed with Charlotte on a different floor instead of with Samantha, and at one point before the baby died, they said they wanted to go home because they were tired, hungry and needed to let their dogs out.

Dr. Suzanne Haney, an Omaha pediatrician who is an expert on child abuse, told Durkan that there was “no medical explanation for the twins’ lack of weight gain.”

Dr. Ann Anderson Berry, the division chief of neonatology at Nebraska Medical Center and an associate professor at the University of Nebraska Medical Center, told The World-Herald that while the twins were high-risk preemies, they should have gained about 5 pounds in the months after their NICU release.

If they had followed normal growth patterns, the girls should have weighed at least 9 to 10 pounds at the time they were admitted to Children’s, she said.

“It’s OK if (babies) stay small, but you have to grow,” Anderson Berry said. “Growth is a very good surrogate for health in general. We get very concerned as pediatricians if our patients aren’t growing.”

Newborns, especially those born prematurely, should be seen regularly by a doctor, she said. If babies are having trouble eating or gaining weight, doctors may suggest extra feedings, fortified formula with extra calories or feeding tubes.

Malnutrition can lead to developmental problems.

“There’s a lot of different resources we have to help with growth,” Anderson Berry said. “There’s a large community of providers that are here in this area just to work with patients like this. But we have to see them.”

Reporter - Education

Erin is an enterprise reporter for the World-Herald. Previously, Erin covered education. Follow her on Twitter @eduff88. Phone: 402-444-1210.

Kevin Cole covers Omaha crime and public safety news. Follow him on Twitter @KevinColeOmaha. Phone: 402-444-1272.

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