Does neonatal and postnatal management of a new-born exposed in utero to tobacco smoking differ from a non-exposed neonate? Which are the biomarkers for perinatal exposition? In order to address these two questions a Medline and Embase search was carried out. For the first question, the review of the literature suggests that tobacco is one of main factors increasing the rates of preterm birth to a significant degree and primarily early prematurity, and intrauterine growth restriction. Moreover, maternal smoking during pregnancy increases perinatal mortality. Management tends to reduce perinatal morbidity and mortality of these new-born, but there is in fact no published research which proposes precise recommendations for an accurate management distinct from the non-exposed child. Among the biomarkers used for the routine diagnosis of in utero tobacco smoke exposure, the umbilical cord cotinine level is probably the most reliable and noninvasive for the new-born. However, the maternal curve can be studied and measurement of the exhaled carbon monoxide in late pregnancy is a valid reflection of neonatal impregnation.