Shakina Rajendram, right, holds her daughter, Adiah, while her sister-in-law, Sharon Nadarajah, holds Adiah’s twin brother, Adrial, at the twins’ first birthday celebration. Born at 22 weeks, Adiah and Adrial hold the Guinness World Record for the world’s most premature twins.Chloë Ellingson/The Globe and Mail
When Adiah and Adrial Nadarajah celebrated their first birthdays this weekend, they also marked a historic first: The two little Canadians now hold the Guinness World Record for the most premature twins to have survived to that age and the lightest twins at birth.
The babies from Ajax, Ont., were born 126 days early, when their mother, Shakina Rajendram, was exactly 22 weeks into her pregnancy. 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.
In the months that followed, “there were times when we watched the babies almost die in front of our eyes,” Ms. Rajendram, 35, told family and friends at her children’s party on Saturday.
“Thank you so much for praying for us,” she said, with her husband, Kevin Nadarajah, 37, standing by her. “Thank you for loving us, for loving the babies from afar.”
The twins’ survival 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 at Toronto’s Mount Sinai Hospital 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 as they died in their parents’ arms.
Parents Shakina Rajendram and Kevin Nadarajah celebrate the first birthday of their twins.Chloë Ellingson/The Globe and Mail
Instead, the twins spent their first birthday bouncing on their parents’ hips. Adiah, dressed in a pink tulle skirt, and Adrial, decked out in suspenders and a pink bow tie, gazed around the party room at a Whitby golf club, smiling brightly at their guests.
At 21 weeks and five days into her pregnancy, Ms. Rajendram went to a community hospital east of Toronto with contractions and bleeding. Medical staff told her she would lose her pregnancy.
Desperate for hope, the couple contacted friends, one of whom connected Mr. Nadarajah with an organization called TwentyTwo Matters, which helps parents of extremely premature babies advocate for resuscitation and intensive care. The couple lobbied to be transferred to Mount Sinai, a downtown Toronto hospital with a high-level neonatal intensive care unit, or NICU, where doctors were willing to try saving infants born at 22 weeks, but no earlier.
Ms. Rajendram arrived at Mount Sinai 21 weeks and six days into her pregnancy.
“At one point we asked, ‘What if the babies are born before midnight?’” Ms. Rajendram recalled in an interview Saturday. “They said there’s a strict cut-off and we only resuscitate after 22 weeks.”
Ms. Rajendram managed to hold on, and Adiah was born at 1:22 a.m. Adrial followed at 1:45 a.m.
The minuscule 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 health scares.
Adiah Nadarajah is held by her aunt Sharon Nadarajah at her first birthday party.Chloë Ellingson/The Globe and Mail
The twins were discharged after more than 160 days in the NICU without the need for any technological support at home.
However, Adrial encountered additional health challenges that led to stints in the NICU at the Hospital for Sick Children in Toronto. He is back home now, and being followed by a team of medical specialists for concerns ranging from his eyesight to a hernia to the scars that his fragile skin collected during his early treatment in the NICU.
“In general he has more medical needs” than Adiah, Ms. Rajendram said, “but we see lots of progress every day. Every other appointment we go to, we get good news that something has resolved.”
Most Canadian hospitals don’t provide resuscitation and active 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.
Kevin Nadarajah holds baby Adiah, top, and Shakina Rajendram holds baby Adrial at the twins’ birthday party.Chloë Ellingson/The Globe and Mail
Ms. Rajendram, an assistant professor at the Ontario Institute for Studies in Education at the University of Toronto, and Mr. Nadarajah, a manager of liquidity risk for Canada Pension Plan Investments, contributed to the article, as did the twins’ social worker, primary NICU nurse and neonatologist.
“Both parents understood the situation well and were not in denial,” wrote Luzia Leong, the twins’ primary NICU nurse. “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 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 one day in 2020. He had a twin sister who died shortly after birth.
“We’re amazed that our twins have the record title,” Mr. Nadarajah said 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.”
Adiah Nadarajah is pictured with party guests while being held by her mother, Shakina Rajendram, at her first birthday party.Chloë Ellingson/The Globe and Mail