Introduction:
According to studies, infant exposure to tobacco smoke is associated with increased perinatal morbidity and mortality, placental disorders, preterm delivery, IUGR newborns, premature rupture of membranes, ectopic pregnancy, miscarriages,^1-4 sudden infant death syndrome,⁵ low birthweight⁶. In addition, infants who live with smokers, during their childhood, may suffer from diabetes mellitus, obesity, hypertension, cancer,^7-11 while during their first year of life, they may suffer from asthma, respiratory infections, recurrent wheezing,¹² otitis media, colic, restless sleep, neurobehavioural disorders^13-15. Preterm birth and NICU stay are stressful situations for parents. On the other hand, NICU admission may provide a unique condition for the immediate change in the parents’ smoking status as neonatal hospitalization has a positive effect on their embracing a smoking cessation intervention, taking into account their neonate’s health. Moreover, during the postpartum period, women often relapse into their previous smoking status, which is usually associated not only with stress and lack of social and medical support but also with cohabitation with a smoking partner. Due to all these, the breastfeeding rate is also affected. Educating the mother, the partner and all the caregivers will contribute to them not returning to their previous smoking status, to maintain a tobacco smoke free domestic environment, to improve infants, toddlers and young children’s health, to avoid re-admission to hospital, to reduce the cost of hospitalization as well as increasing the breastfeeding rates. Finally, it must be noted that new mothers who smoke are highly likely to show symptoms of depression, which may prevent the success of the smoking cessation intervention and lead to relapse into their previous smoking status^16,17. Midwives are the health professionals who come into contact not only with women but the entire family during the antenatal period. More specifically, during the postpartum period, midwives provide women with counsel on a number of issues including both women’s and infants’ care and health as well as breastfeeding. Therefore, midwives develop a direct, close and durable relationship with women and their family, which makes them some of the most significant professionals capable of providing counselling with regards to smoking cessation and prevention of relapse, making use of well-grounded intervention techniques aiming at smoking cessation, after having been trained in the field. Research suggests that smoking cessation intervention conducted by midwives during the perinatal period has, in fact, high success rates^18-20.

Material and Methods:
A targeted intervention will be implemented focused on the neonatal primary caregivers who smoke (or are passive smokers) and their neonates had to be admitted to NICU right after birth. The approach will take place between 1st and 3rd day of neonate’s life. During the first meeting, a midwife trained in smoking cessation will administer questionnaires (demographics etc.), and the Fagerstrom Test for Nicotine Dependence as well as recording smoking history. She will also provide information and self-help leaflets on smoking cessation, have the consent form signed, implement motivational interviewing and schedule the next meeting. In addition, emphasis will be placed on beginning, establishing and maintaining breastfeeding. Some of the tools that will be used include the smoking cessation consult form ‘TiTan Crete’ (University of Ottawa Heart Institute, 2015), the Edinburgh Postnatal Depression Scale (EPDS) and the 5As approach. There will be three follow-up meetings (on a weekly basis) during which smoking cessation intervention and assessment of the venture will take place. During the first three months of infant’s life, there will be a meeting (online, by phone or in-person during the NICU follow-up) so as to ascertain whether the change in smoking status is maintained after the infant has been discharged and has returned to the domestic environment. Also, relapse likelihood as well as second-hand and third-hand tobacco smoke exposure will be examined. The study sample will consist of Greek adult parents or different nationality parents who will have knowledge of the Greek language. The parents will be smokers (providing they smoke one cigarette on a daily basis, or have stopped smoking upon being informed about the pregnancy or one month earlier or a few days before) or passive smokers, their neonates will be born in the General and Maternity Hospital Helena Venizelou and will be admitted to the Neonatal Intensive Care Unit. Participants will be excluded from the study if they suffer from severe cognitive impairment or any other psychiatric disorder, which excludes them from the study protocol. The control group (same study inclusion criteria as the intervention group) will only be provided with printed information and self-help material on smoking cessation.

Results:
Through the smoking cessation intervention, smoking parents/main caregivers are expected to be supported and aided in quitting smoking so as to maintain a smoke free domestic environment and welcome their neonate after discharge from the NICU. Thus, the risk of smoking relapse is reduced and the infant’s health is promoted, as well as the parents’ and the family’s overall.

Conclusions:
Smoking parents and caregivers pose a serious threat to both their own and their infant’s health. Second-hand and third-hand tobacco smoke exposure will affect their infants’ life until they reach adulthood. Planning targeted smoking cessation interventions during the postpartum period may contribute to promoting the health of not only the entire family but also society as the health of the individual will be maintained at all stages of life (neonate, infant, child, adult) and the cost of pharmaceutical treatment and hospitalization in NICU and ICU will be reduced.