Twins Adiah and Adrial Nadarajah of Ajax, Ont., were born 126 days early and now hold the Guinness World Record for the most premature twins to have survived to their first birthdays.Supplied
Two tiny Canadians now hold the Guinness World Record for the most premature twins to have survived to their first birthdays.
Adiah and Adrial Nadarajah were born at Toronto’s Mount Sinai Hospital 126 days early, when their mother, Shakina Rajendram, was exactly 22 weeks into her pregnancy. The previous record holders, twin girls from Iowa, were born at 22 weeks and one day.
Adiah was 330 grams at birth, about the weight of a can of soup. Adrial weighed 420 grams, or a little less than a pound, when he and his sister were born on March 4, 2022.
“We’re amazed that our twins have the record title,” said Kevin Nadarajah, the twins’ father, in a video posted Saturday, as the Guinness World Records organization announced the news. “But beyond that, I think what we’re really happy about and passionate about is that this is going to help push the dialogue on viability. We do hope this is a record that gets broken.”
The twins’ story highlights the medical and moral challenges that arise when babies are born at the border of viability. Ms. Rajendram gave birth to her son and daughter shortly after midnight on the day she reached the 22-week mark of pregnancy – a critical threshold. Had she delivered just a few hours earlier, the babies would have been offered nothing more than comfort care and died in their parents’ arms.
Mom Shakina Rajendram holds Adiah Nadarajah March 31, 2022 nearly four weeks after birth in the Neonatal Intensive Care Unit at Mount Sinai Hospital in Toronto.Courtesy of family
“I was just in tears,” Ms. Rajendram said in the video, describing how she felt when she thought her water had broken too early. “I felt so distraught that I wasn’t able to hold the babies for just another half hour.”
Ms. Rajendram managed to hold on, and Adiah was born at 1:22 a.m. Adrial followed at 1:45 a.m.
The miniscule infants hovered at the edge of life. Their delicate skin was nearly transparent, their eyes fused shut. They required mechanical ventilation and suffered brain bleeds, among other life-threatening complications.
Most Canadian hospitals don’t provide resuscitation and intensive care to babies born earlier than 23 weeks gestation. Mount Sinai is one of a select few that does, according to an article about the Nadarajah twins’ case in a recent edition of the Canadian Medical Association Journal.
Ms. Rajendram and Mr. Nadarajah contributed to the article, as did the twins’ social worker, primary neonatal intensive care unit (NICU) nurse and neonatologist.
“None of us knew what the long-term consequences of the twins’ medical problems would be; however, one thing was certain – their parents would never give up hope,” wrote neonatologist Prakesh Shah, Mount Sinai’s pediatrician-in-chief.
“Many of my colleagues and team members kept asking, ‘Are we doing the right thing?’, ‘What are we trying to prove here?’ and, most importantly, ‘Do the parents understand the challenges they’ll face in the future?’ ”
Dr. Shah and the other contributors to the CMAJ article, including Luzia Leong, the twins’ primary NICU nurse, believed they did.
“Both parents understood the situation well and were not in denial,” Ms. Leong wrote. “It was Kevin and Shakina’s eagerness to overcome any challenges that inspired myself and the whole NICU team to let go of our personal struggles and dedicate our very best.”
In 2021, 40 per cent of babies born at 22 weeks received active care in the delivery room, according to the most recent report from the Canadian Neonatal Network, which tracks outcomes for babies born at 33 high-level NICUs. Of the 22-weekers who received intensive care, 27 per cent survived. The chances of survival usually rise with each week of gestational age.
Adiah was 330 grams at birth, about the weight of a can of soup. Adrial weighed 420 grams, or a little less than a pound, when he and his sister were born on March 4, 2022.Supplied
As a general rule, even the Canadian hospitals with the most sophisticated NICUs, such as Mount Sinai, don’t offer active resuscitation to babies born before 22 weeks gestation. That is something Mr. Nadarajah and Ms. Rajendram would like to see change.
The Guinness World Record holder for the most premature single baby to survive is Curtis Zy-Keith Means, an Alabama boy born at a gestational age of 21 weeks and 1 day in 2020. He had a twin sister who died shortly after birth.
Adiah and Adrial were discharged after more than 160 days in the NICU without the need for any technological support at home.
“They both have unique personalities,” Mr. Nadarajah said in the video, which shows the twins smiling and laughing.
“Adiah is a fun, cheerful girl and she likes to laugh and babble and go on walks while she’s being held. Adrial, on the other hand, is very analytical. He looks to look at things and he’s very observant.”