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DOI:10.1097/MOP.0000000000000604 The topics included in the Neonatology and Perinatology section of this issue of Current Opinions in Pediatrics share the common theme of refinement. Whether it be recognition of knowledge gaps regarding commonly used medications or management algorithms, improved identification of infants most likely to benefit from treatment, or real-time monitoring of the newborn’s response to interventions, all authors present compelling data that we need to continue to strive for improvement. As one of the few evidence-based medications to decrease the risk of bronchopulmonary dysplasia (BPD), caffeine therapy has become commonplace in many neonatal intensive care units. Gentle et al. (pp. 177–181) review the history of caffeine use in preterm infants and summarize the data regarding its safety and efficacy for the treatment of apnea of prematurity and for the prevention of neonatal morbidities such as, BPD and neurodevelopmental impairment. The authors caution that despite its extensive use, significant questions remain regarding optimal dosing and timing of initiation and discontinuation of caffeine therapy. Sanlorenzo et al. (pp. 182–186) present the evolving epidemiology of neonatal abstinence syndrome (NAS) – one of the most significant public health issues in neonatology today. They review emerging data regarding the impact of polysubstance exposure and specific host genetic polymorphisms on the risk and severity of NAS and present updated, evidenced-based approaches to the assessment and treatment of opioid-exposed infants. The authors highlight the importance of standardizing management strategies, as this is associated with both shorter duration of therapy and decreased hospitalization days for affected newborns. Two of the manuscripts in this issue address the topic of newborn resuscitation. In the first, Hooper et al. (pp. 187–191) provide a thoughtful review of the physiology underlying neonatal transition to the extrauterine environment. The authors present specific management strategies that may best assist the infant during each of the three defined phases of transition: lung aeration, liquid accumulation in lung tissue, and stabilization of lung function and