‘0% chance of survival’: World’s most premature twins defy doctors

By Sanj Atwal
split image of worlds most premature twins

When Shakina Rajendram went into labour after just 21 weeks and 5 days – over four months early – she was told that the pregnancy was a loss, and nothing could be done to save her twins.

Her babies were “not viable,” doctors said. “0% chance of survival.”

However, one year later, both Adiah Laelynn and Adrial Luka Nadarajah, from Ontario, Canada, are alive and kicking, ready to celebrate their first birthday today as the world’s most premature twins.

Adiah and Adrial were born 126 days early, on 4 March 2022, breaking the previous record of 125 set by Keeley and Kambry Ewoldt (USA, b. 24 November 2018).

Weighing just 330 g (0.72 lb), baby girl Adiah was born 23 minutes before her brother, Adrial, who weighed 420 g (0.92 lb). At a combined 750 g (1.65 lb), they are the lightest twins at birth ever.

The record-breaking Nadarajah twins entered the world at a gestational age of exactly 22 weeks. If they’d been born even one hour earlier, no attempt would have been made to save their lives.

Adrial (left) and Adiah (right)

“When I went into labour, the babies were denied all life-sustaining measures at the hospital I was admitted to and almost left to die,” Shakina revealed.

This was her second pregnancy; Shakina sadly lost her first pregnancy just a few months prior, at the very same hospital.

"We were in shock," she recalled.

The only consolation the hospital could offer was ‘comfort care,’ whereby the babies would be placed on top of Shakina while they slowly passed away.

“No words could capture the emotional, mental and physical trauma we experienced in the moments that transpired.” - Shakina

The twins’ father, Kevin Nadarajah, recalled being awake at night, “face streaming with tears,” praying for a sign of hope.

The next day, Kevin received that sliver of hope he’d been wishing for, as Shakina was transferred to Mount Sinai Hospital in Toronto, which specializes in resuscitating 22-week-old babies.

For context, most hospitals do not attempt to save babies born before 24-26 weeks.

Adrial immediately after his birth

Even though Shakina was now in Mount Sinai’s specialist neonatal intensive care unit, the situation still looked bleak.

It was Shakina’s second day of labour - 21 weeks 6 days into the pregnancy - and she was informed that if the babies were born even a few minutes before they turned 22 weeks old, they would be left to die.

Even if they did make it to 22 weeks, Shakina and Kevin were dissuaded several times from resuscitating the babies.

“We were told it would be a ‘death sentence’ for them and they would have many disabilities, but we insisted on the babies being given a chance to live.” – Shakina

Shakina had been bleeding heavily throughout the day, but she tried her best to “hold the babies in.”

However, half an hour before midnight, she felt her water break. She was devastated.

“I thought that this was it,” she remembered. “They are gonna die and it’s gonna be because of me.”

Fortunately, Shakina was informed that her water had not actually broken. Exhausted, the soon-to-be mother quickly fell asleep.

Adiah immediately after her birth

Shakina awoke 15 minutes after midnight, and this time her water was breaking for real.

Miraculously, within an hour and a half, at a gestational age of 22 weeks 0 days, both twins were born and successfully resuscitated.

However, the battle was only half won.

Adiah and Adrial remained in the hospital’s care for almost six months, facing complications with brain bleeding, sepsis, and fluid management. Both babies had extremely thin, transparent skin.

Adrial in Mount Sinai's NICU

The second week after being born, Adrial suddenly developed an intestinal perforation, which led to a blood stream infection and significant inflammation throughout his whole body. His fragile skin suffered extensive peeling each time the catheter required redressing.

“We watched the babies almost die before our eyes many times,” Shakina shared.

Adiah opening her eyes for the first time

Adrial holding Shakina's finger

Shakina and Kevin were asked several times to consider withdrawing medical care, but that only served to strengthen their resolve; the parents were determined to save their babies.

Whilst doctors were focusing on possible risks and future outcomes, Shakina and Kevin chose to focus on the progress their babies were making instead.

They spent up to 12 hours each day by the twins’ sides, holding their hands and singing to them. After 161 days in the NICU, Adiah was cleared to be discharged, with Adrial following a week later.

“We finally got to bring them home - with no breathing or feeding tubes.”

Shakina tandem holding the twins for the first time

Adiah and Adrial sharing a crib for the first time

Since being discharged, Adiah has been growing “really well” and meeting all the milestones for her corrected age, according to Shakina.

A premature baby’s corrected age is their chronological age minus the number of weeks or months early they were born.

Adiah now weighs around 6 kg (13.2 lb), which is 18 times heavier than her birth weight.

“She’s an extremely happy and social baby, and smiles all day long,” Shakina revealed. “She is very chatty and has ‘conversations’ with us and her toys for hours.”

Adiah (left) and Adrial (right) at seven months old, or a corrected age of three months

Adrial has been admitted back to the hospital twice since being discharged, spending several weeks fighting off infections and respiratory issues. After returning from his last hospitalization, he required home oxygen support.

Adrial has now outgrown his twin sister and is “progressing well.”

Shakina describes him as “observant, attentive, and intelligent,” and - much like his parents - he loves music.

“It was very difficult for us having Adiah at home and Adrial in the hospital, but thankfully Adrial is back home now, hopefully this time for good!”

Real-life superbabies

Adiah and Adrial meet Eden the Bernedoodle

Shakina and Kevin are devout Christians, and they believe that the power of prayer – from friends, family, and even strangers worldwide - helped save the twins’ lives.

“The babies were close to death so many times, and as people prayed, things would miraculously change,” Shakina explained.

Both Adiah and Adrial continue to be monitored by a long list of medical specialists – cardiologists, respirologists, ophthalmologists, dermatologists, and haematologists, just to name a few – but in general the twins are “doing great” and exceeding expectations.

We’re wishing Adiah and Adrial – the world’s most premature twins – a very happy first birthday and look forward to them celebrating many more in the future!

Nadarajah family photo

The most premature baby ever was Curtis Zy-Keith Means (USA), born to Michelle Butler on 5 July 2020 at a gestational age of 21 weeks 1 day, making him 132 days premature.

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