FORT WORTH - The delivery was uncomplicated. But just a few hours after his birth, the tiny baby boy began vomiting and crying inconsolably.
He wasn't fighting an infection. The newborn was suffering withdrawal from the methadone his mother took while he was in the womb.
With gradually decreasing doses of morphine, the medical staff at John Peter Smith Hospital's neonatal intensive care unit worked to lessen the baby's withdrawal symptoms and wean him off the narcotic prescription drug.
"He started having symptoms three or four hours after birth. He cried different. He didn't want to eat," neonatologist Dr. Jose Arellano said. "It took a week before he could handle feeding well."
The baby, released from the hospital this month after two weeks of care, is one of 12 to 16 babies the Tarrant County hospital delivers each year who are born with neonatal abstinence syndrome from being exposed to drugs while in the womb. Though the percentage of babies born addicted to these drugs in the county is small -- one or two cases a month per hospital -- the trend is growing at an alarming rate nationally.
A national study published this year in the Journal of the American Medical Association reported that the number of babies treated for drug withdrawal after birth nearly tripled between 2000 and 2009, rising from 1.2 out of every 1,000 babies born in a hospital to 3.4 out of every 1,000 babies.
These newborns, exposed to illegal drugs or prescription painkillers such as Vicodin and Oxycontin, were also significantly more likely than other babies to have low birth weight and respiratory complications, and require an average of $53,400 in hospital treatment, the study found.
"Speaking with some of my neonatology colleagues, they describe it as the most concerning trend that exists in NICU today," said Dr. Glenn Hardesty, an emergency room physician at Texas Health Arlington Memorial Hospital.
According to the national study, about 13,539 infants a year are born addicted to drugs. Neither Tarrant County Public Health nor Child Protective Services had data on how many cases of neonatal abstinence syndrome are reported locally, and Texas statistics weren't readily available.
Texas Health Harris Methodist Hospital Fort Worth, which delivers more than 3,000 babies each year, reported that the staff there has not "seen a huge prevalence of this issue with our moms and infants."
Doctors at Cook Children's Medical Center do not recall treating a newborn for drug withdrawal during the past three years.
But, like JPS, Arlington Memorial reported seeing one or two cases each month of newborns who have to be treated for drug withdrawal.
Some of these newborns, Hardesty said, are "the tiniest victims" of the growing prescription drug abuse trend in America.
"It's a huge problem. It stems from a well-intended pain initiative 10 or 15 years ago saying we were undertreating pain," Hardesty said. "What happened was a lot of unintended drug addictions."
Hardesty said about one-third of the pregnant women he treats in the hospital's emergency department test positive for some form of drug, including opiate-based pain killers.
"Oftentimes, they don't know they are pregnant. They start taking these pain pills, and once they become addicted, they are addicted," Hardesty said.
About 4.5 percent of pregnant women use illegal drugs or prescription drugs recreationally, said Andreea Creanga, a researcher with the Centers for Disease Control and Prevention.
"Instead of using street drugs, they are now using prescription drugs nonmedically," Creanga said.
Even if medical workers aren't aware of the mother's drug abuse before she delivers, Hardesty said, it doesn't take long for them to realize something is wrong with the affected babies, who often have a high-pitched cry and are difficult to console.
"The babies certainly do not behave normally. They experience a similar withdrawal that a person would -- shaking, chills, diarrhea, a sense of pain all over," Hardesty said. "When you remove the drug, you have this huge surge of pain because for so long the pain receptors have been blocked. It would be a horrendous thing for a child to go through."
Neonatal abstinence syndrome symptoms, however, can mimic other medical problems, such as infection, which requires testing to be ruled out.
"They can have sweating. They can have fever. They cry a lot. They don't sleep well," said Arellano, adding that some babies also suffer from seizures. "We start suspecting there is something that is not correct. That is when we start asking the mother for more information."
Though doctors educate expectant mothers on the dangers of ingesting anything that could cross the placenta and harm their baby, the message may not get through to those who are already addicted, Hardesty said.
"It's a bad thing that happens but what are going to do about it? Are we going to start criminally charging these women? That is what you are going to have to do," Hardesty said. "If the child was out of the womb and she gave it drugs, she would be arrested immediately without a second thought."
Texas is one of 16 states and the District of Columbia that report infants showing signs of drug exposure at birth to child protective services, according to the Child Welfare Information Gateway website. But mothers who are found to have exposed their unborn children to narcotics do not face criminal charges of injury to a child or endangering a child under an exception within state law, according to the Tarrant County District Attorney's Office.
"Texas penal code precludes district attorneys' offices from filing criminal charges against women who ingest drugs during pregnancy," Assistant District Attorney Rainey Webb said.
Parents involved in neonatal abstinence cases are typically required to participate in drug testing and treatment, counseling, parenting classes and other programs, CPS spokeswoman Marissa Gonzales said. In some situations, the baby could be placed with a relative or friend, or in a foster home, Gonzales said.
The baby born addicted to methadone, for example, was released into his grandmother's care after he was weaned off the drug, which his mother reportedly told hospital staff she was taking for pain.
Because about half of all pregnancies in the United States are unintended, the CDC is pushing for doctors such as primary care physicians, gynecologists and obstetricians to screen all reproductive-age women for signs of substance abuse.
"We do want to do something about it before a woman gets pregnant. If a woman is using drugs and she needs treatment, we can advise her to use protection or to avoid getting pregnant before getting treatment," Creanga said.
Substance abuse treatment during pregnancy, Creanga said, has been shown to result in increased fetal growth and a reduction in poor outcomes for the baby, such as low birth weight, pre-term delivery or death. Babies also can suffer from feeding and respiratory issues, and memory and focus problems.
"It is clearly preventable. We have got to try to do something about it," Creanga said.
To raise awareness about these risks and identify women who may need help, Dr. Vivek Mehta, Arlington Memorial's pain management medical director, advocates that doctors use a simple, nonjudgmental questionnaire to learn whether a patient has a history of drug, cigarette or alcohol use or is exposed to drugs by their parents or sexual partners.
Mehta also stressed the importance of exercise, physical therapy, family support and a switch to safer pain medications, such as aspirin, to help pregnant moms who had been taking prescription drugs for chronic pain.
Substance abuse by expectant mothers has financial consequences. In 2009, treating newborns with neonatal abstinence syndrome cost $720 million, according to the national study published in the Journal of the American Medical Association. Nearly 78 percent of mothers whose infants were born drug-addicted that year were covered by state Medicaid programs, the study reported.
"There is a huge cost to society. The taxpayer ends up paying for this," Hardesty said.