Neonatologists Reflect on Caring for Nash Keen, the Most Premature Infant to Survive
Introduction
Welcome to the Empowering NICU Parents’ Podcast!
Our podcast is dedicated to supporting, educating, and empowering parents navigating the challenges of having a baby in the NICU.
As we continue to recognize NICU Awareness Month, we were honored earlier this month to share the story of a resilient little boy, Nash, and his family. If you missed that conversation, be sure to go back and listen to Episode 74, Hope Against All Odds: Nash Keen’s Journey as the Most Premature Infant to Survive, where his mom, Mollie, so beautifully shared their journey.
But NICU Awareness Month is not only about celebrating the babies and their families—it’s also about honoring the care team who stand beside them with unwavering dedication, expertise, and compassion.
Today, as we shift to the clinical perspective, I’m honored to be joined by two of the neonatologists who cared for Nash and stood by his family from the initial moments of his life and continue to see him in the follow-up clinic today —Dr. Patrick McNamara and Dr. Amy Stanford of the University of Iowa Stead Family Children’s Hospital. Nash was born at 21 0/7 weeks’ gestation, making him the youngest gestational age infant known to survive.
In this episode, you will hear what first drew each of them to neonatology and how the culture and belief within the NICU walls at the University of Iowa shapes everything from decision-making to outcomes. Learn how they balance honesty and hope in early viability conversations, and get insight on what Nash’s stabilization and first critical weeks really looked like. You will also hear the profound impact it has on providers—both professionally and personally—when babies like Nash not only survive against all odds but are finally able to go home with their families who have waited and prayed sometimes for many months for that unforgettable moment.
This conversation is not just about pushing boundaries in neonatology—it is about the power of belief, the importance of a unified culture, and how families and clinicians together can change what is possible. It’s an episode every NICU parent, clinician, and advocate will want to hear.
The Why Behind Empowering NICU Parents – Empowering NICU Parents' Podcast
- The Why Behind Empowering NICU Parents
- From NICU Experience to Nonprofit Mission: A Family’s Journey to Today Is a Good Day
- The Lifelong Journey and Impact of Premature Birth: What Families Should Know
- Wave of Light: Finding Light After Loss
- Culture, Belief, and a Committed Team: The University of Iowa NICU Redefines What’s Possible
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Episode 75
Our Guests
Dr. Amy Stanford
Amy Stanford, MD is a Clinical Assistant Professor of Pediatrics in the Division of Neonatology at the University of Iowa. She earned her B.S. at Iowa State University and her M.D. at the Roy J. and Lucille A. Carver College of Medicine, followed by pediatric residency, neonatal-perinatal medicine fellowship, and targeted neonatal echocardiography training at the University of Iowa.
Dr. Stanford’s clinical expertise includes the care of extremely preterm infants and neonatal hemodynamics. Her research interests focus on the phenotypes of chronic pulmonary hypertension in extremely premature infants with bronchopulmonary dysplasia, where she serves as a co-research mentor with Dr. Patrick McNamara.
Dr. Patrick McNamara
Patrick J. McNamara, MB, BCh, BAO, DCH, MSc (Paeds), MRCP, MRCPCH is the Regan Giesinger Professor of Neonatology at the University of Iowa, where he serves as Professor of Pediatrics, Professor of Internal Medicine in Cardiovascular Medicine, Division Director of Neonatology, and Vice Chair for Inpatient Acute Care in the Stead Family Department of Pediatrics.
Dr. McNamara earned his medical degree (MB, BCh, BAO) from Queen’s University Belfast and trained extensively in pediatrics and neonatal medicine across Ireland, the United Kingdom, and Canada—including neonatal transport at The Hospital for Sick Children in Toronto.
He is internationally recognized as a leader in neonatal hemodynamics, having established one of the first dedicated neonatal hemodynamic programs in North America. His work integrates advanced echocardiography into neonatal care, with a focus on improving diagnosis, precision-based treatment, and outcomes for critically ill newborns.
Building a Culture of Belief
The University of Iowa is world-renowned for its care of extremely premature infants, and at the heart of that success is a culture of belief. Every member of the NICU team, from neonatologists and nurse practitioners to dietitians and respiratory therapists, shares the conviction that even the smallest babies deserve a chance to survive and thrive. This belief is not abstract—it is reflected in how the unit is structured, with a dedicated small baby program, consistent protocols, and seamless communication between providers. Families are spared the confusion of conflicting messages, because the care team speaks with one unified voice.
Dr. McNamara adds that this culture is what sets Iowa apart. In many centers, he notes, doubt or inconsistency can undermine outcomes. At Iowa, standardized care is layered with precision-based medicine, allowing the team to balance structured protocols with individualized treatment tailored to each baby’s unique physiology. It is this combination of belief, consistency, and innovation that has led to survival stories once thought impossible.
Understanding Neonatal Hemodynamics
One of the most compelling parts of this conversation is Dr. McNamara’s explanation of neonatal hemodynamics—a field he helped establish that has transformed care for fragile infants. He compares it to taking your car to a mechanic: if a mechanic replaces ten parts before finally fixing the real problem, you would be frustrated and wonder why they didn’t diagnose it correctly the first time. For decades, this has essentially been how neonatologists have approached cardiovascular instability in premature infants—making decisions based on low blood pressure or generalized assumptions, rather than truly understanding what was happening inside the heart and blood vessels.
Hemodynamics changes that. By using targeted echocardiography (ultrasound of the heart), neonatologists can now look directly at how a baby’s heart is functioning, how blood is flowing, and how organs like the brain and intestines are being perfused. This allows the care team to diagnose problems earlier and more precisely, and then select treatments that match the baby’s actual physiology, rather than relying on one-size-fits-all approaches.
At the University of Iowa, hemodynamic screening has become a standard of care for extremely premature infants. It means that instead of waiting for babies to become critically ill, physicians can identify risk factors early, tailor interventions, and provide close follow-up. Dr. McNamara and Dr. Stanford describe how this precision-based approach not only improves outcomes but also helps families better understand their baby’s condition and the rationale behind each decision.
Nash’s Arrival at 21 0/7 weeks’ gestation and beating the odds
When Nash was born at 21 0/7 weeks’ gestation, no infant at that exact gestational age had ever survived. Dr. McNamara recalls telling his parents with complete honesty that Nash’s chance of survival was “zero”—not because the team lacked hope, but because there was no precedent in medical literature. Yet, he reassured them that the Iowa NICU would do everything possible to give Nash a chance. This balance of honesty and hope is central to how the team approaches conversations with families at the edge of viability.
Dr. Stanford was at Nash’s delivery and remembers the tension of those first moments. The immediate question was whether he would be big enough for their smallest breathing tube or intravenous lines. When the team successfully intubated him and saw his heart rate respond, relief and determination filled the room. Those first minutes were not only a test of skill but also a reflection of the Iowa NICU’s culture—every person in the delivery room believed Nash deserved a chance.
The early days that followed were filled with enormous challenges. Nash’s blood pressure was undetectable at birth, his lungs were extremely fragile, and his skin was paper-thin, making fluid and electrolyte balance especially difficult. A devastating complication—a spontaneous intestinal perforation—required surgery on an extremely tiny infant, and even then, survival rates were grim. Yet, thanks to the coordinated efforts of neonatologists, nurses, respiratory therapists, and pediatric surgeons, Nash pulled through. Each step was an illustration of resilience: a baby defying statistics, and a team leaning on training, protocols, and belief to support him through the most fragile days of life.
Supporting Family’s in the NICU
While advanced medicine plays a critical role, both Dr. Stanford and Dr. McNamara emphasize that caring for micropreemies is about supporting families as much as treating babies. At the University of Iowa, families are active participants in daily rounds, encouraged to share observations and ask questions. Physicians and trainees are reminded that parents know their babies best, and their concerns are taken seriously. That respect not only builds trust, but also ensures subtle changes are never overlooked.
The team is also intentional about empowering parents to take part in their baby’s care. For many families, the thought of touching or holding a baby so small is overwhelming. Nurses gently coach them through skin-to-skin care, diaper changes, and feedings—transforming fear into confidence and helping parents bond with their child during even the most uncertain days. Dr. Stanford reflects on how important it is for families to feel safe and supported in those first interactions, and how those moments often become turning points in the NICU journey.
Beyond bedside care, Iowa’s NICU provides structured resources such as support groups, social work services, and fellow involvement that create continuity and connection for families who may spend months in the unit. Fellows, who rotate through more consistently, often build particularly close relationships with parents, serving as trusted allies who are present across long stretches of the hospitalization. Families are reminded to care for themselves, too—because the NICU, as Dr. Stanford notes, “is a marathon, not a sprint.”
In all these ways, the Iowa team recognizes that survival is not only about medical milestones, but also about ensuring families feel heard, supported, and empowered as parents. This holistic approach is part of what makes the NICU’s culture so unique and impactful.
Reflections on Nash and the Broader Impact
For both Dr. McNamara and Dr. Stanford, seeing Nash go home after spending months in the NICU is profoundly meaningful—not only as physicians, but as human beings who walked alongside his family through every fragile moment. They describe follow-up clinic visits as the “reward” for long nights at the bedside, where the tiny baby they once fought to stabilize is now thriving in the arms of his parents. These reunions bring the entire team joy and serve as powerful reminders of why they dedicate themselves to such demanding work.
Caring for Nash also represents something larger: a testament to what can be achieved when a NICU embraces belief, teamwork, and precision-based care. Each success story builds on the lessons of those who came before, fueling Iowa’s drive to keep improving outcomes for the most vulnerable infants. For Dr. Stanford, the most meaningful part is seeing these babies fully integrated into their families and communities—children who, to the outside world, appear like any other, with no hint of the extraordinary battle they once fought.
Ultimately, Nash’s survival is not only a personal triumph for his family but also a source of pride and hope for the entire NICU team. For the physicians who cared for him, it reaffirms that their tireless work, constant reflection, and culture of belief are not in vain—because each time a baby goes home, the impossible has been redefined once again.
Lessons for Other NICUs
The success seen at the University of Iowa is not the result of a single protocol or innovation, but rather the product of a carefully built culture, dedicated infrastructure, and a unified team belief that even the smallest babies can survive. Both Dr. McNamara and Dr. Stanford emphasize that this culture of belief is not optional—it is foundational. Without it, protocols are inconsistently applied, teams are divided, and families may receive mixed messages. The Iowa experience shows that when every member of the team, from physicians to respiratory therapists to bedside nurses, embraces the same commitment, outcomes begin to shift.
Another lesson is the importance of consistency and standardization. Iowa’s “small baby” program ensures that extremely premature infants are cared for in a dedicated space with a core team trained specifically in their needs. This avoids the variability that can occur when care practices change from one provider or shift to another. Yet, standardization alone is not enough. It must be paired with precision-based medicine—recognizing that each baby’s physiology is unique and requires tailored interventions, particularly in areas such as hemodynamics, lung support, and nutrition.
Dr. McNamara also points to the need for centers of excellence. While many NICUs across the country care for preterm infants, not every center has the infrastructure, patient volume, or specialized expertise to consistently manage babies born at 21 or 22 weeks. Attempting to do so without the right systems in place may unintentionally compromise outcomes. Instead, he encourages regional and national discussions about how to best concentrate expertise so that fragile infants receive care in units equipped and experienced enough to give them the best chance.
Finally, Iowa’s model highlights the importance of humility and continuous learning. Every case, whether successful or not, is an opportunity to reflect, adapt, and improve. This willingness to evaluate past decisions, update practices, and learn from both setbacks and triumphs has allowed the team to continually refine their approach. For other NICUs, the lesson is clear: advancing care for extremely premature infants requires not only skill and resources, but also a collective mindset of belief, teamwork, and relentless improvement.
🏅Guinness World Record
Nash Keen is now officially recognized by Guinness World Records as the most premature baby to survive. Because Nash was born at 21 weeks and 0 days, they knew early on that he could potentially become the new record holder. Later, Dr. Bell from University of Iowa Stead Family Children’s Hospital stopped by Nash’s room and told them this was possible if they were interested, and helped them begin the process.
Mollie said she wasn’t prepared for what came next—once the announcement was made, it went viral. Her social media feeds were flooded with messages, tags, and interview requests. While the attention was overwhelming, she said it was worth it because she wanted other parents to hear their story and know that this is possible.
Closing
Thank you to Dr. Amy Stanford and Dr. Patrick McNamara for sharing their wisdom, experiences, and hearts with us today. Your unwavering dedication to the tiniest and most fragile babies—and to the families who love them—is truly inspiring.
Nash’s journey reminds us that survival at 21 0/7 weeks’ gestation is not only a remarkable milestone in medicine, but also a reflection of the culture within the University of Iowa NICU. It’s a place where belief and teamwork drive every decision, where humility fuels reflection and growth, and where every baby and family is cared for with extraordinary dedication and compassion.
And as we close out NICU Awareness Month, we honor all who are part of this journey—the resilient and strong babies, the courageous families who stand by their side, and the dedicated professionals who walk beside them and fight for them every single day. Together, you remind us of the power of hope, the strength of teamwork, and the possibility of brighter futures for even the most fragile infants.
Thank you for joining me for this powerful conversation. Until next time, may we continue to honor the strength of NICU babies, the courage of their families, and the relentless dedication of the care teams who make survival stories like Nash’s possible.
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