In April 2021, The University of Alabama at Birmingham Regional Neonatal Intensive Care Unit team celebrated as Curtis Means
was discharged after 275 days in the hospital. Six months later, Curtis and his team held another celebration as he was officially named the World’s Most Premature Infant To Survive by Guinness World Records.
As fireworks filled the Fourth of July night sky, Michelle Butler went into labor at only 21 weeks and one day gestation. She raced to her local hospital and was soon transferred to AB Hospital, where she gave birth to premature twins, Curtis and C’Asya, around
1 p.m. on July 5, 2020.
Brian Sims, M.D., Ph.D., professor of pediatrics in the UAB Division of Neonatology, was the attending physician on-call when Butler arrived.
“Numbers show that babies born so young have little to no chances of survival,” Sims said. “We typically advise for compassionate care in situations of such extremely preterm births. This allows the parents to hold their babies and cherish what little time they may have together.”
Sims told Butler the care team would take their lead from the babies, see how they respond and let them tell the team what path to take. The twins had a less than 1 percent chance of survival.
The RNICU team jumped into action. Nurses started post-birth care, and respiratory therapists quickly hooked them up to ventilators and oxygen, all hoping to increase the babies’ chances of survival. C’Asya soon showed signs she was too premature. She passed away a day later.
Curtis, however, showed signs of improvement. His heart rate and oxygen levels increased with resuscitation and additional oxygen. He was fighting for life.
It Takes A Village
When Colm Travers, M.D., assistant professor in the Division of Neonatology, arrived at the UAB RNICU the next morning, he was astounded to see Curtis alive and responding well to treatment. Travers researches periviable infants, those born at the limits of viability, and could not recall knowing of an infant surviving at a younger gestational age than Curtis.
A baby born that young takes it one step at a time. After surviving the first day, Curtis needed to make it through the first week. The RNICU team immediately activated the AB Golden Week Program TA, a multidisciplinary effort that includes clinical guidance on respiratory support, thermoregulation, nutrition and fluid management, infection prevention, and neurological status.
“When taking care of severely premature babies, you have to take it step-by-step and day-by-day, said Travers, who is co-director of the Golden Week Program™. “The program combines evidence-based medicine and best practices to increase a premature baby’s survival chances during their first week of life. The program has resulted in a marked reduction in mortality or severe intraventricular hemorrhage
within the first week of life.”
Curtis continued defying odds, to his family’s and the team’s amazement. He survived the first week. Then the first month. His journey at UAB, however, was far from over, Curtis received ’round-the-clock care over the next nine months. Speech therapists worked to help him start using his mouth and learn to eat. Respiratory therapists supported his breathing through various efforts as he came off the breathing machine. Nurses provided daily care, from checking vitals to soothing him to sleep, to supporting Butler as she learned the intricate care Curtis needed.
“There were days when we were unsure that he would survive,” said Sumita Gray, an RNICU nurse on Curtis’ team.
“He was the youngest baby anyone had worked with, but we are a level 4 RNICU and knew we had the resources and expertise to support Curtis and his mom. We were determined to see him go home.”
Graduation Day
After 275 days in the UAB RNICU, Curtis was discharged on April 6, 2021, a day filled with joy and a little disbelief. A baby with a less than 1 percent chance of survival was healthy enough to go home to his family.
The team gathered to give their goodbyes and offer words of advice to Butler, specifically to enjoy the time she has with Curtis.
“Being able to finally take Curtis home and surprise my older children with their younger brother is a moment I will always remember,” Butler said. “It was a difficult journey, but I am grateful for the UAB team and their constant support. They took the time to educate me and made sure I knew what was happening every step of the way. They truly cared about my son and me.”
Before leaving, Travers reminded Butler about a conversation they had when Curtis was born. Travers thought that Curtis may be the youngest baby born not only in the country, but in the world. Travers continued researching records during Curtis’ stay and never found a more premature infant who survived. With Butler’s permission, Travers reached out to Guinness World Records in hopes his hunch was correct.
World Record Holder
Six months after Curtis’ discharge, his care team gathered outside the UAB Women and Infants Center, where he was born. There they surprised Butler and Curtis with an important certificate that read:
Guinness World Records — The most premature baby to survive is Curtis Zy-Keith Means (U.S.A.) who was born to Michelle Butler on 5 July 2020 at the University of Alabama at Birmingham Hospital in Alabama, U.S.A. at a gestational age of 21 weeks 1 dav or 148 days, making him 132 days premature.
The team saw the culmination of their collaboration, research, programs and expertise in the smile of a happy, healthy 1-year-old boy.
“Curtis defied all scientific odds.” Travers said. “Gestational age and birth weight are two key predictors of a premature baby’s survival, and other factors include if the baby is a female, a single birth and if the mother was administered steroids that help with lung development before birth. Curtis did not meet any of these criteria.
While Curtis presented a unique opportunity for the NICU team to put years of practice, experience and research to the test, he also offered the team a unique opportunity to study something that no other hospital in the world has had the opportunity to do.
“He is truly the world’s N=1 baby,” Sims said. “We do not know what all the future will hold for Curtis since there is no one else like him. He started writing his own story the day he was born. That story will be read and studied by many and, hopefully, will help improve care of premature infants around the world.”
