Abstract. Second-hand smoke exposure is a signiﬁcant health risk to newborn infants, particularly preterm infants with underlying respiratory disorders. Smoking cessation counseling during all phases of pregnancy and 23-valent pneumococcal polysaccharide vaccine (PPSV23) administration to adult smokers is advocated by multiple healthcare organizations but faces barriers to implementation. The neonatal intensive care unit is an ideal arena for providing smoking cessation counseling to parents because advice from pediatric caregivers is well received. High parental immunization rates for PPSV23 may also be achieved with NICU-bedside vaccination.