Brothers born at 21 weeks and set record for most premature twins in the world

For future parents Shakina Rajendram It is Kevin Nadarajah the doctor’s words were final and devastating: her twins were not “viable”.

“Even at that moment, as I heard those words come out of the doctor’s mouth, I could still feel the babies very much alive inside me. And so for me, I just couldn’t comprehend how the babies that felt very much alive inside of me couldn’t be viable,” Rajendram recalled.

Still, she knew there was no way she could carry the pregnancy to term. She started bleeding and the doctor said she would give birth soon.

The prospective parents were told that they could hold their babies but that they would not be resuscitated as they were too premature.

Rajendram, 35, and Nadarajah, 37, got married and settled in Ajax, east of Toronto, Canada, to start a family.

They had conceived once before, but the pregnancy was ectopic – outside the womb – and ended after a few months.

As devastating as the doctor’s news was, Nadarajah said they both refused to believe their babies would not survive. And so they scoured the Internet, finding information that both alarmed and encouraged them.

The babies were just 21 weeks and five days pregnant. To stand a chance they would need to stay in the womb an extra day and a half, and Rajendram would have to go to a specialized hospital that could treat “microprematures”.

The earlier a baby is born, the greater the risk of death or severe disability, say the US Centers for Disease Control and Prevention.

Babies born prematurely, before 37 weeks of gestation, can have breathing problems, digestive problems and brain hemorrhages. Developmental challenges and delays can also last a lifetime.

Problems can be especially serious for micropremature infants, those born before 26 weeks of gestation.

Research found that babies born at 22 weeks who receive active medical treatment have survival rates of 25% to 50%, according to a 2019 study.

Rajendram and Nadarajah requested a transfer to Mount Sinai Hospital in Toronto, one of the few medical centers in North America that provides resuscitation and active care in the 22nd week of pregnancy.

They say, they “prayed a lot”, with Rajendram determined to keep the babies inside her just a few hours longer.

One hour after midnight on March 4, 2022, at 22 weeks pregnant, Adiah Laelynn Nadarajah he was born. His brother, Adrial Luka Nadarajah joined her 23 minutes later.

According to Guinness World Records, the two are the youngest and lightest twins ever born.

The previous record holders for preterm twins were the Ewoldt twins, born in Iowa at a gestational age of 22 weeks and 1 day.

It’s a record these parents say they want to break as soon as possible so more babies have the opportunity to survive.

“They were perfect in every way for us,” said Rajendram. “They were born smaller than the palm of our hand. People still don’t believe us when we tell them.”

“They are definitely a miracle”

The babies were born at just the right time to be eligible for proactive care, resuscitation, nutrition and vital organ support, according to Mount Sinai Hospital.

Even an hour earlier, the care team may not have been able to intervene clinically.

“We don’t really understand why that strict cut at 22, but we know the hospital had its reasons. They were in uncharted territory and I know they possibly had to create some parameters of what they could do,” Rajendram said.

“They are definitely miracles,” said Nadarajah, describing seeing the twins in the neonatal intensive care unit for the first time and trying to come to terms with what they would go through in their struggle to survive.

“I had challenging feelings, conflicting feelings, seeing how tiny they were on the one hand, feeling the joy of seeing two babies in the second hand. I was thinking, ‘how much pain are they in?’ It was so conflicted. They were so little,” he said.

These risks and setbacks are common in the lives of micropremature infants.

The Doctor. Prakesh Shah, the chief pediatrician at Mount Sinai Hospital, said he was direct with the couple about challenges ahead for their twins. He warned of a fight just to keep Adiah and Adrial breathing, let alone feed them.

The babies weighed little more than a soda can, their organs visible through translucent skin. The needle used to feed them was less than 2 millimeters in diameter, about the size of a fine knitting needle.

“At some point, many of us would have thought, ‘Is this the right thing to do for these babies?’ These babies were experiencing a lot of pain, distress and their skin was peeling.

Even removing the surgical tape would mean their skin would peel off,” Shah told CNN . But what their parents saw gave them hope.

“We could see through their skin. We could see their hearts beating,” said Rajendram.

They had to consider all the risks of moving forward and agreeing to more and more medical interventions.

There could be months or even years of painful and difficult treatment ahead, along with the long-term risks of things like muscle development problems, cerebral palsy, language delays, cognitive delays, blindness and deafness.

Rajendram and Nadarajah didn’t dare hope for another miracle, but say they knew their babies were fighters and resolved to give them a chance at life.

“The strength that Kevin and I had as parents, we had to believe that our babies had the same strength, that they had the same resilience. And so yes, they would have to go through the pain, and they will continue to have a hard time, even into adulthood, not just as premature babies. But we believed that they would have a stronger determination, a resilience that would enable them to overcome those painful moments in the NICU,” said Rajendram.

There were painful setbacks over almost half a year of treatment in the hospital, especially in the first few weeks.

“There were several instances in the early days where we were asked about withdrawing care, that’s just a fact, and those were the times when we just came together in prayer and saw a turnaround,” said Nadarajah.

The twins can be pioneers

Adiah spent 161 days in the hospital and returned home on Aug. 11, six days before her brother, Adrial, joined her there.

Adrial’s road has been a bit more difficult. He was hospitalized three more times with various infections, sometimes spending weeks in the hospital.

Both brothers continue with specialized tests and various types of therapy several times a month.

But new parents are finally more at ease, celebrating the arrival of their babies and learning all they can about their personalities.

The twins are now reaching many of the baby milestones for their “corrected age”, where they would have been if they had been born at full term.

“The thing that really surprised me, when they were both ready to go home, they both went home with no oxygen, no feeding tube, nothing, they just went home. They were feeding on their own and maintaining their oxygen,” Shah said.

Adiah is now very sociable and has long conversations with everyone he meets. His parents describe Adrial as wise for his age, curious and intelligent, with a love of music.

“We think it’s very important to point out that, contrary to what was expected of them, our babies are happy, healthy, active babies, breathing and feeding themselves, rolling over, babbling all the time, growing well, playing and having fun,” said Rajendram.

These parents hope that their story will inspire other families and healthcare professionals to reassess the issue of viability before 22 weeks of gestation, even when faced with worrying survival rates and long-term disability risks.

“Even five years ago, we wouldn’t have done this if it weren’t for the best help we can offer now,” Shah said, adding that medical teams are using life-support technology better than in previous years.

“It’s allowing us to sustain these babies by helping to maintain oxygen in their bodies, the role of carbon dioxide, without causing lung damage.”

Adiah and Adrial’s parents say they don’t expect perfect children with perfect health, but they are striving to provide the best life possible for them.

“This journey has empowered us to champion the lives of other premature babies like Adiah and Adrial who would not be alive today if the limits of viability had not been challenged by their healthcare team,” said Rajendram.