More than half the babies in University Hospital's neonatal intensive care unit one day this month were suffering from drug withdrawal - one sucking licorice-flavored morphine to ease his tremors and near-constant crying, another so sensitive to light and sound that he slept in a dark isolation room.
They are the tiniest victims of Kentucky's prescription pill epidemic, and their numbers are soaring.
Kentucky has seen its hospitalizations for addicted newborns climb from 29 in 2000 to 730 last year. The state's 2,400% increase dwarfs by comparison a disturbing national rise of 330% found in a study that examined hospitalizations from 2000 to 2009.
"It's a silent epidemic that's going on out there," said Audrey Tayse Haynes, secretary of the Kentucky Cabinet for Health and Family Services. "You need to say: 'Stop the madness. This is too much.'"
The skyrocketing numbers reflect the enormity of Kentucky's prescription drug abuse problem, which is among the nation's worst. It kills about 1,000 Kentuckians a year and wrecks thousands more lives in a state plagued by doctor shortages, high levels of chronic pain and illness, and too little drug abuse treatment.
Van Ingram, executive director of the state Office of Drug Control Policy, requested statistics on Kentucky infant hospitalizations - collected for the first time - after hearing that the state's pain pill explosion was fueling a dramatic rise in addicted newborns. He soon realized the state's epidemic is threatening to claim a second generation.
"I was blown away," he said. "We need to slow the tide."
While state officials and doctors say the hospitalization statistics reflect newborns suffering withdrawal from all types of drugs, they blame prescription pills for the dramatic increase. And even as growing awareness and better diagnoses play a role in the rising numbers, they say rampant abuse is driving the rise.
Melissa Lueloff, 28, of Louisville, who gave birth to an addicted girl two years ago, said her cravings at the time for OxyContin, Opana and cocaine ruled her life even during pregnancy - "I just couldn't stop."
Neveah was born a month premature and spent five days in a neonatal intensive care unit struggling with withdrawal, constantly clenching her tiny fists and whining in pain.
A silent epidemic
Nurse Tonya Anderson, an infant development/touch therapist for neonatal nurseries at Kosair Children's Hospital, said there are times when as many as 14 of 26 babies in the special-care nursery where she works suffer from withdrawal.
"They are just agitated. They are screaming. They have tremors. Their faces - you have the grimace. They're in pain. ... Sometimes, the babies have seizures," she said. "We hate it. €1/8 It breaks my heart to see these babies go through withdrawal."
As nurses and doctors care for the newborns, state and hospital officials are trying to cope with the larger problem - convening experts, seeking grants to educate the public and creating special infant-withdrawal units in hospitals.
But there's not enough drug treatment for pregnant addicts, they say, and more needs to be done to protect the lives the addicts carry.
Carla Saunders, a neonatal nurse practitioner at East Tennessee Children's Hospital in Knoxville, a pioneer in the treatment of babies withdrawing from drugs, said the public simply cannot afford to ignore this national epidemic.
A team of researchers writing in the Journal of the American Medical Association in May found that overall health care costs for addicted newborns are soaring - from $190million in 2000 to $720million in 2009.
Addicted babies stayed an average of 16.4 days in the hospital at a cost of $53,400 per infant, with government-funded Medicaid paying the bill in 80% of cases.
And while little is known about long-term outcomes, evidence suggests that addicted babies may have higher rates of behavioral issues and attention deficit and hyperactivity disorder that could burden schools and the health care system for years to come, Saunders said.
"People think it's easy to ignore the substance-abuse problem," she said. "But it's your problem. You better take notice."
According to the May study in the Journal of the American Medical Association, the rate of newborns suffering withdrawal in the United States rose from 1.2 hospitalizations per 1,000 hospital births in 2000 to 3.4 per 1,000 in 2009. Doctors call the condition "neonatal abstinence syndrome."
Based on their findings, researchers estimated that 13,539 newborns were born addicted in 2009 - more than one baby every hour.
"We knew that it was common, but we would not expect this problem would have tripled in the last decade," said Dr. Matthew Davis, an associate professor at the University of Michigan and one of the study's authors.
In Kentucky, the number of hospitalizations for addicted newborns rose from 470 in 2009 to 730 in 2011. Saunders said the number of addicted babies at her Tennessee hospital has more than tripled in the past three years.
According to the JAMA study, 60% to 80% of infants exposed to opiates in the womb develop neonatal abstinence syndrome.
While babies do not show signs of psychological addiction, they experience the physical effects of withdrawal.
By that time, the mother's drugs are out of the newborn's system, and "they're basically looking for their fix, so they have this withdrawal," said Dr. Henrietta Bada of UK.
Many cry constantly. Some suffer diarrhea, vomiting, low-grade fevers, sweating and seizures. They're extra-sensitive to noise and light and often console themselves by sucking.
At Kosair Children's recently, one newborn girl sucked frantically on an orange pacifier and squeezed her eyes tightly closed, opening them only when nurses dimmed the lights.
Bada said some born prematurely experience respiratory distress and have to be placed on ventilators. They "can get into critical condition," she said.
Devlin-Phinney said doctors often use a combination of oral morphine and phenobarbitol to treat addicted babies, escalating doses based on symptoms and then weaning the infants from them.
Babies with milder cases don't need medicating, doctors said, but all require comfort measures. Anderson swaddles the babies in blankets to make them feel secure, massages them gently, and rocks and cuddles them.
"Sometimes," she said, "all we can do is hold them."
When a woman gives birth to an addicted baby, she can face serious consequences.
Criminal charges, however, are unlikely. Although women have been charged over the years with taking drugs while pregnant, a 1993 Kentucky Supreme Court ruling found that criminal child abuse doesn't extend to a woman's use of drugs while pregnant, Assistant Commonwealth's Attorney Leland Hulbert said.
But giving birth to a drug-affected baby can bring in child-protective services. Doctors and advocates said some women then go through treatment and keep their babies, but others lose custody. UK doctors said about four in 10 drug-affected babies can't go home with their mothers.
"A lot of these moms are very loving moms," said Dr. Lori Shook, a UK neonatologist. "They're just not at a point in their lives when they can take care of a baby."
Tara Glover, a family advocate for Volunteers of America whose own son was born withdrawing from drugs nearly two decades ago, said many people see addiction as a moral failing instead of a disease. "But addicts aren't bad people," she said. "They're sick people."
Lueloff said she was at one of the lowest points in her life when she gave birth to Neveah, who was placed with a foster family and then an aunt.
But after becoming pregnant again, Lueloff sought help at a house run by Volunteers of America's substance-abuse services. She wiped away tears as she recalled getting sober and giving birth to a healthy son less than a year ago, her fifth child.
"This place has changed my life," she said.
Lueloff has regained custody of Neveah, is living on her own with her children, and beginning management training for McDonald's. She said she's bonding with her daughter, who used to consider caregivers her parents.
"Now," Lueloff said, twirling her hands through her daughter's black ponytail, "she's calling me Mommy."