A tour of the neonatal intensive care unit could only prepare Matt and Nicole Kivisto so much for the first few weeks of their baby boys' lives.

But they knew they were lucky.

"We knew we'd be in ICU," Matt Kivisto said. "They have people in ICU, and they did not know (they would be there). We were prepared and still in shock with our own children. It's unexplainable."

More than four years later, the blue knit caps Lucas, Cade and Jayden wore in the NICU work better as mittens. They will be 5 in November. They were born two months early.

Prematurity is common in multiple births, but it even happens in single births. A premature baby is born three or more weeks early.

In North Dakota, 1,017 of the 8,205 babies born were premature last year, according to statistics from the North Dakota Chapter of the March of Dimes. Premature birth is the leading cause of death among newborns.

It was at 10 weeks when Nicole Kivisto found out she would have triplets. She and Matt had thought they would have a small family, maybe just with their daughter Jenna, but then they thought they'd have one more. Jenna is now 7.

"They keep us laughing," Nicole Kivisto said. "We thought we'd have two kids; now we have four. It's a blessing. I can't imagine life without them."

After the boys were born, the Kivistos were in the neonatal intensive care unit almost around the clock. Nicole would be there during the day, and Matt would be there at night. The boys spent the first few weeks of their lives in NICU. Cade and Jayden spent five weeks and Lucas spent seven weeks.

The first time Nicole Kivisto saw her boys in the protective walls of the isolettes, she cried.

"When you look at them in the isolette, you can do absolutely nothing," she said.

They were in the hands of the doctors, the Lord and March of Dimes research, she said. March of Dimes has funded research that has prevented some types of disabilities caused by premature birth.

When babies are born premature, there are developmental risks and delays. For some premature babies, they can have hearing problems, vision problems and cerebral palsy, said Mary Tintes, community director of the North Dakota Chapter of the March of Dimes.

The Kivisto boys' development and health are fine. They are in preschool and keeping up, Nicole Kivisto said. Cade likes sports, Jayden, who will quickly tell you he likes to be called "J.J.," likes dinosaurs and Lucas likes fireworks.

They like to wrestle, play with cars and are excited to use the trampoline they got for Christmas.

J.J. uses his imagination to play, giving voices to his toys, his parents said. He sat on a chair in his family's living room holding two toy animals - one a tyrannosaurus rex - and making voices for them as he played with them. Cade was throwing a small football around, after he finished tumbling off the couch and Lucas likes to do his own thing, Matt Kivisto said.

But sometimes, the boys scheme when they play. The family keeps some games up on a high shelf, and the boys moved some large plastic totes over to the shelf unit to use as steps to climb up and get the games, Matt Kivisto said.

The family has made some adjustments to having a larger family. Matt Kivisto moved to part time at NISC, a computer information company in Mandan, after his wife was promoted a little over a year ago. Nicole Kivisto works in accounting as a controller at MDU Resources.

During Matt Kivisto's extra time at home, he picks up Jenna from school and the boys from day care, cleans the house and prepares dinner. Jenna likes the extra time with her father and getting picked up from school.

Matt and Nicole Kivisto want to help decrease the odds of premature babies having developmental problems, and for fewer babies to be born premature.

They learned how they could support March of Dimes research through the nurses they met in the NICU. They heard them talk about Walk America, a fundraiser to raise money for premature birth research.

"We have a lot of people close to us who had premature babies, and they had health issues," Matt Kivisto said. "They all went through ICU, and we walk for them, too."

The Kivistos are the ambassadors for the Bismarck Walk America on April 21. The walk starts at the Heritage Center at 9 a.m. Registration is at 8 a.m., or people can preregister 10 a.m. to 2 p.m. at US Bank on April 20.

Last year, the walk raised $194,000. Walkers raise $200 or more to participate.

"It builds awareness and raises money," Tintes said. "Eighty-one to eighty-two percent of the money goes back into programs and research."

Donating to March of Dimes is one way Nicole Kivisto gives back for the help her boys received in the NICU. They also received several blood transfusions, and her goal for a time was to give back as much blood as they used. It took a toll on her body, and she could no longer donate. Now her mother is donating blood in the spirit of her cause.

For families experiencing a premature birth, the Kivistos recommend the parents rely on their doctors and family.

"That's hard to do," Matt Kivisto said. "Take all the help you can get."

(Reach reporter Sara Kincaid at 250-8251 or sara.kincaid@;bismarcktribune.com.)