Ten years later, the smell of the industrial cleaner commonly used in hospitals still hits Kristin Moan hard, reminding her of the harrowing days after her daughters were born.

"When I come across that same soap it just stops me in my tracks," she said. "You just instantly get thrown back into this gut-wrenching situation where you just don't know what to do, and it takes a few seconds for me to breathe."

When twins Dylan and Hayden were born 23 weeks into Moan's pregnancy, they were what's called "micro-preemies" — babies born so prematurely that until recent years they almost certainly would not have survived. Even now, extremely premature infants often face health challenges or lifelong disabilities. Moan's newborns weighed just over a pound apiece, measuring less than a foot long.

"Five sticks of butter," Moan's mother would say as comparison.

The girls spent their first 119 days in a neonatal intensive care unit (NICU), hooked to monitors and ventilators and feeding tubes, as Moan and her husband, Eric, stood by watching helplessly.

"I honestly didn't think I would get to take them home," said Moan, who lives in Nowthen. "I honestly never thought that I would get to hold them."

Several days after they were born, Eric Moan went toy shopping, less for the babies' sake than to lift the parents' spirits. He selected Mr. and Mrs. Potato Head, the iconic Hasbro toys introduced in the mid-20th century. Unlike a plush stuffed animal, a plastic Potato Head could be wiped down with sanitizer.

But the toys served another purpose. At 7.6 inches, a Potato Head is bigger than the infants were when they curled up. Right away, the Moans began taking weekly photos of the twins lying next to the Potato Heads. Watching them gradually grow in relation to the toy gave them some comfort.

Not long after that, Moan's mother heard that a friend's daughter had just had a micro-preemie and suggested that Moan send a Potato Head to her. So she did, and after that word of the Potato Heads gradually spread, by mouth and in Facebook groups for mothers of multiples.

Fast forward 10 years. Dylan and Hayden are lively fourth-graders who help their mom box up Potato Heads and other small gifts (lip balm and hand lotion because NICUs can be dry, and baby leg warmers the size of a folded dollar bill) to parents of micro-preemies around the country as the nonprofit Potato Head Project.

Moan figures she has sent out thousands of Potato Heads over the decade, showing parents they're not alone, offering support and, perhaps, a little hope.

"You want to be really careful about spreading false hope, but hope is hope," she said. "Let's say the worst thing happens and your baby doesn't survive. You didn't lose anything by staying hopeful or positive before that."

Parents who've received Potato Heads say the toys help brighten what was possibly the hardest time of their lives.

"It was very helpful to know that people have experienced the things we have, and seen the things we have, and gone through the things we have, and come out on the other side," said Cara Nelson of Ramsey, who received Potato Heads when, like the Moans, she and her husband had premature girl twins. Their daughters, born at 26 weeks and one day, recently turned 5.

"If you look at them now you really wouldn't know they were 1½-pound babies," Nelson said.

Outlook has improved

A standard human pregnancy lasts 40 weeks. Babies born before 37 weeks — about one in 10 babies in the United States — are considered premature, and face higher risk of health complications than do full-term infants. The earlier the birth, the greater likelihood of problems.

Babies born at less than 22 weeks still rarely survive. In 2020, a baby born at 21 weeks and two days, cared for in the NICU at Children's Minnesota in Minneapolis, made a Guinness World Record. That was broken a month later by a baby born at 21 weeks and one day (the previous record of 21 weeks and 5 days was set in 1987).

The outlook for premature babies has improved significantly in recent years. Babies born at 23 weeks, like the Moans', now have much better odds.

"I have a cousin who is 22 now and was born at 23 weeks — she's in a wheelchair and she has several health complications," said Heather Irrthum of Big Lake, Minn., who received a Potato Head when her son was born at 26 weeks and four days. He's now a small but healthy 7. "It's amazing how far the technology has come, the things that they can do now to help these little babies be successful and healthy and come home."

The first time Moan saw her daughters, the twins "were in the corner and there was a [full-]term baby between them in an open crib," she said.

The contrast was jarring. "I thought, look at that healthy baby and then look at these babies that have translucent skin and they're not moving and their bodies are shaking only because of the ventilator they were on."

For a while, Moan didn't dare even touch her delicate daughters. "My husband was like, 'You have to do it, they have to know you're there.' I remember sticking my finger in just touching the tip of their finger and that was it — that was how I got to bond with them."

There were many close calls. Dylan suffered an intestinal infection and "turned a color of green I didn't even know your body could do," Moan said. Hayden, they were told, might never walk or talk.

More than once, they were urgently summoned to the NICU to say goodbye.

'Write your journey down'

While their daughters were in the NICU, the Moans kept a journal. Sample entry: "At 9 p.m. we got a call from Doctor Heather, you had a major spell and quit breathing. ... Mommy is so very scared and is praying a lot that you are going to be OK. Please stay strong, we love you so much."

The couple looked for one of those baby memory journals — in which parents write about birthdays, holidays and other "firsts" — except tailored for premature babies in the NICU. They couldn't find one.

So in 2018 they published their own, "My Preemie Baby Book: The Story of My Days in the NICU" (illustrated by Megan Kampa). In it, parents can record milestones like "First time we held you," "First time you came off oxygen," "First time you went without your feeding tube."

"I know it matters to write your journey down," Moan said. "Take all the pictures. Going through the experience in the NICU, you don't think you're going to want to remember it but you really truly do."

Looking back now, Moan said, "you could say that we got really lucky."

Nowadays Hayden wears glasses; Dylan is legally blind in one eye, has balance problems and learning disabilities.

"So here's the deal," Moan says she tells Dylan when her daughter complains about her schoolwork. "I'm really sorry you have to struggle in school. But the other alternative is ... you're not here.

"Either way, you still have to do your homework."