They are the tiniest victims of the heroin epidemic, babies who suffer withdrawal symptoms after being exposed to their mothers' drug use.
In Winchester, Virginia, an area hard hit by drug overdose deaths, health care and law enforcement officials are waging a community-wide effort to tackle the issue. At Winchester Medical Center, about 12 miles southwest of the West Virginia border, doctors and nurses began to notice an increase in signs of trouble in newborns about two years ago.
It's called neonatal abstinence syndrome. When babies are exposed to heroin or other opioids in the womb, they experience withdrawal.
"The babies are very irritable. Their muscle tone is increased. They are very jittery ... they are very difficult to console. They spend a lot of time and energy crying," said Dr. Teresa Clawson, the medical director of Winchester Hospital's neonatal intensive-care unit.
Feeding babies suffering from heroin withdrawal is difficult, and if they go untreated, the babies may fail to thrive.
"Those babies need to get those symptoms captured pretty quickly or they are going to get into trouble," Clawson said.
In response to the troubling trend, Winchester Medical Center has steadily ramped up its approach to helping babies suffering because of their mothers' heroin abuse. The hospital runs a toxicology screening on all women who go to the hospital to deliver babies.
If the test finds a mother likely was exposed to the drug, an umbilical cord sample also is taken. As of last month, every baby who shows signs of heroin withdrawal goes straight to the neonatal intensive-care unit (NICU).
"We have just transitioned to admitting all babies into the NICU who require medical management of their neonatal abstinence syndrome because we weren't able to do it ideally in the newborn nursery," Clawson said.
On most days, Winchester Hospital treats two to five infants in the NICU for withdrawal symptoms.
In the NICU, dark, quiet private rooms help with treatment. So do volunteer cuddlers, like retired teacher Cindy Cartee. She's part a group created to give the babies comforting they desperately need.
"It's just such a serious need because these babies are so precious, and they just need someone to come in and hold them," said Cartee, who makes the 30-minute drive from Martinsburg, West Virginia to the hospital every Friday.
"It's important for each baby to find a position that makes them comfortable," the volunteer cuddler said. "For this baby here, she enjoys snuggling on your shoulder."
The hospital's aggressive protocols already are showing results. In the past six months, the length of the hospital stays of these babies has been cut nearly in half from an average of 40 days to just 21 days.
The treatment doesn't stop with the babies. The hospital and its parent company, Valley Health, are targeting the mothers to guide them into treatment or keep them on the path to recovery. Valley Health is helping to fund a social worker from the community services board who works with local obstetricians and at the hospital to make sure the mothers can tap into community resources.
"We're trying to connect with the moms as early in pregnancy as possible," nurse case manager Mari DeLalla said.
Winchester's police chief first sounded the alarm about the impact of the heroin and opioid abuse epidemic about three years ago. That's when the number of overdose deaths in the city jumped from 1 in 2012 to 33 last year. A series of community summits has led to the funding and creation of a drug treatment court.
"In law enforcement, we realized we can't arrest our way out of this situation, that we need to rethink the way we do business, so we reached out to our community partners, and one of our great partners has been Valley Health," Police Chief Kevin Sanzenbacher said.
The long-term goal of a community coalition of law enforcement, health care and civic leaders is eventually to create a center that could offer treatment to those who aren't insured or can't afford other treatment facilities in the area. Workers at the center also could help drug offenders with re-entry after they have served jail terms or been referred by the drug court.
"What we really need to do is step back and say, the issue here is the treatment of addiction and accessible affordable care for people wanting to move from addiction to recovery, and having a community that embraces that this as a disease and not a moral failing," Valley Health vice president Dr. Nick Restrepo said.