DES MOINES, Iowa — Shorter than a Barbie doll and lighter than a football, Kambry Ewoldt entered the world fighting to survive.
Kambry and her identical twin sister, Keeley, were born Nov. 24, 2018, around the 22-week mark of the pregnancy of their mother, Jade Ewoldt. They weighed 15.8 ounces and 1 pound 1.3 ounces, respectively, and spent the first four months of their lives in the Neonatal Intensive Care Unit at the University of Iowa Stead Family Children's Hospital before they could go home.
Guinness World Records has recognized them as the world's most premature twins.
Today, the girls love singing "Baby Shark," doing the Chicken Dance and painting pictures. They have their own personalities — Kambry is more of a tomboy and Keeley is very girly, Ewoldt said — and are excited to celebrate their second birthdays.
It's a milestone they weren't guaranteed.
Ewoldt, already a mother of two, knew having twins meant it would be a high-risk pregnancy.
At 16 weeks, doctors told Ewoldt her daughters had twin-to-twin transfusion syndrome, where they were sharing blood through blood vessels in the womb. If untreated, the syndrome can be deadly to babies.
″(TTTS) is also very rare,” Dr. Jonathan Klein, a neonatologist and medical director of the NICU at University of Iowa Stead Family Children’s Hospital, told The Associated Press in January 2019, about two months after the Ewoldt twins were born. “A lot of patients pass away before they are even born.”
At 17 weeks, Ewoldt underwent surgery at Cincinnati Children’s Hospital to seal and disconnect the twins' aberrant vessels.
Most mothers deliver their babies within 10 weeks of the surgery, and Ewoldt was no exception — Keeley and Kambry were born about a month later on Nov. 24.
For the next five months, Ewoldt was split between two worlds: the hospital and home.
She made a two-hour round-trip commute almost every day from her home in Dysart — and her two older children, Koy and Kollins — to her newborn daughters. Constantly driving back and forth, she said, put her in "survival mode."
"It was hard to leave the NICU knowing that I was having to compartmentalize life," she said. "Leaving behind the twins, knowing I couldn’t take them home was painful and then (I was) going home to be with my other kids and shutting off thinking about the twins when I was with them."
As tiny infants, Kambry and Keeley were diagnosed with severe bronchopulmonary dysplasia, a chronic lung disease that makes breathing difficult. They have had to receive oxygen through nasal cannulas almost their entire lives, but were able to be taken off oxygen earlier this month.
Klein told the Des Moines Register, part of the USA TODAY Network, that even though the babies missed most of their lung development in utero by being born so early, they have done "extremely well" in their development.
"I would consider anytime babies like this on the cusp of viability survive, that it’s a pretty amazing situation, and it’s a huge dedication to a large team," he said.
Life didn't stop throwing obstacles in the Ewoldts' path when Jade was able to bring her babies home. The twins are more susceptible to illness and last year had six hospital stays for the common cold.
"Something you or I would get the sniffles over would put them in the ICU," Ewoldt said.
Although COVID-19 poses a significant risk to the twins, she said the family was already taking precautions against any sickness by staying indoors most of the time. It's not perfect, but at least her family is together.
"I still feel torn between the two sets of kids, but at least I know, at the end of the day, the older kids get to do normal things where the twins get to stay healthy and I don’t have to decide between the two," she said.
November is a month full of meaning for the family. It's the twins' birthday month, and the birthday month for their older sister, Kollins, who will turn 5 on Nov. 30. World Prematurity Day, a day created by March of Dimes to support families of premature babies, was Nov. 17, and November is Prematurity Awareness Month.
It's also the month Ewoldt said goodbye to her sister Baylee Hess, who died in a crash last year on Kollins' birthday as she was driving to her parents' house to watch movies with her mom. Hess, 26, collided with a tractor-trailer, and died at the scene.
As the family celebrates the twins at home this year, their birthday will be dedicated to Baylee, Ewoldt said.
"This is a month of many emotions, but I want to practice Thanksgiving," she wrote in a Nov. 1 Facebook post on her page called "Keeley and Kambry's Tribe." "I’m thankful for the uneven road that brought us here even when I do not understand."
With nearly 10,000 Facebook followers, Ewoldt hopes their story can reach and support families going through similar struggles.
Years before she was pregnant with twins, without knowing the information may help save her future children, Ewoldt saw a story about a family that did not have the opportunity to intervene when they received a twin-to-twin transfusion syndrome diagnosis and lost their children.
When she received the same diagnosis, that story affected her decisions, she said. She hopes to pay it forward by sharing the knowledge she has gained.
"If our story can help save another baby, then it’s really important to continue to share," she said.
Contributing: Associated Press
This article originally appeared on Des Moines Register: World's most premature twins to turn 2 in Iowa: Guinness World Records