Michelle Butler was 21 weeks pregnant with twins — a boy and a girl — when she felt contractions.
As her sister drove her to the hospital, Ms. Butler prayed for them to stop.
But the contractions persisted and on July 5, 2020, at about 1 p.m., the babies, C’Asya Zy-Nell and Curtis Zy-Keith Means, were born. She was told that the infants, who each weighed under a pound, had less than a 1 percent chance of survival. They were quickly placed on ventilators.
C’Asya died less than a day later. Ms. Butler, 35, said she had held her in her arms, prayed for her and told her she loved her.
But Curtis hung on. He was trying to breathe on his own and his heart rate was improving, showing a resilience that shocked longtime nurses and doctors at the University of Alabama at Birmingham.
“He was striking even from the first breath,” said Dr. Brian Sims, a neonatologist at the hospital who cared for Curtis. “He just showed that he was going to be a strong, strong fellow from Day 1.”
Curtis was released in April, after 275 days in the neonatal intensive care unit. On Wednesday, Guinness World Records named Curtis, who was born 132 days early, the world’s most premature infant to live to a first birthday. He is now 16 months old.
Babies born that premature seldom live more than a day, Dr. Sims said.
“The truth is no baby has survived at this age,” he said. “We say less than 1 percent, but it’s really closer to zero.”
Curtis’s early birth reflects the persistently high frequency of premature births in the United States, where the yearly rate of preterm births hovers at about 10 percent, according to the March of Dimes. In Alabama, the rate was 12.5 percent in 2019, according to the organization.
Curtis was born one month after the previous record-holder, Richard Hutchinson, who was born in Minneapolis after only 21 weeks and two days of gestation.
The risk of preterm births is even higher for Black women, who are over 50 percent more likely than white women to give birth early, according to the Population Reference Bureau.
Myriad factors can contribute to premature births, including a mother’s age and income, her health and her access to prenatal care. Access to contraception can play a role. Women who have pregnancies in quick succession are also at risk of giving birth early, said Bruce Bekkar, a gynecologist and obstetrician who serves as the chairman of the Public Health Advisory Council at the Climate Action Campaign in San Diego.
Climate change could be exacerbating the problem, according to a 2020 study that examined more than 32 million births in the United States and found that pregnant women exposed to high temperatures or air pollution were more likely to have children who were premature, underweight or stillborn.
It is too early to conclude how large a role climate change is playing in low birth weights and preterm births, said Dr. Bekkar, one of the authors of the 2020 study. But the evidence that it is a significant factor is compelling, he said, noting that the number of preterm births fell at least 20 percent in California in areas where fossil fuel plants shut down.
Other events caused at least in part by climate change, like the growing number of wildfires in the western part of the United States and the increasing frequency and intensity of heat waves, have been associated with preterm births.
“It’s going to get worse,” Dr. Bekkar said. Climate change “is going to continue to put increasing pressure on premature birthrates.”
Dr. Sims said it was not clear why Ms. Butler went into early labor. She had access to neonatal care and saw a doctor regularly, he said.
Ms. Butler said her cervix began to open up shortly before the birth. She underwent surgery at UAB Hospital to close it and was discharged from the hospital on July 4. Her sister was driving her home over severely bumpy roads when she began feeling the contractions, Ms. Butler said.
She said that when her daughter died, she had little time to grieve, knowing that Curtis was still trying to survive.
“I had to pull myself together and be strong for him,” Ms. Butler said. The doctors told her that with a baby born that early, they would have to “take it day by day, hour by hour.”
“It was a roller coaster,” Ms. Butler said. “He had his good and bad days, for sure.”
Ms. Butler, who also has a 7-year-old daughter and a 14-year-old son, drove 90 minutes several days a week from her home in Greene County, Ala., to visit Curtis at the hospital.
The nurses showed her how to feed him, change him and keep his feeding tube clean.
When he was stable enough, he was placed on his mother’s chest for skin-to-skin contact, said Sumita Gray, a nurse in the hospital’s regional neonatal intensive care unit.
Ms. Butler balanced visits to the hospital with her job at a catfish processing plant. Two weeks before Curtis was discharged, Ms. Butler quit her job, knowing she would need to spend more time with the baby.
Ms. Gray said she was thrilled when she saw him recently, when the doctors and nurses who cared for Curtis reunited with him and Ms. Butler to present them with the Guinness World Records plaque.
“He looked great,” she said. “He was roly-poly.”
Curtis still relies on a feeding tube and a nasal cannula, which helps supplement his oxygen. He needs speech and physical therapy, Ms. Butler said. But the doctors said they were pleased with his progress.
“He’s very interactive,” Dr. Sims said. “He laughs, he gets an attitude. All the things that you expect from a baby so far, he does those things.”
Ms. Butler said Curtis, who now weighs 18 pounds 9 ounces, sleeps all night and seldom whines.
“He’s a happy baby,” she said. “He’s not a crybaby.”