Objective: To compare the accuracy of infrared temporal artery thermometry with axillary thermometry in a cohort of preterm neonates between 28 and 36 weeks postmenstrual age. Design: Descriptive repeated measures design with randomization to temperature measurement order. Setting: Level III NICU in the Central/Southeastern United States. Participants: Sixty-eight neonates born between 28 weeks and 36 weeks postmenstrual age cared for in incubators or open cribs. Methods: Neonates were randomly assigned to temperature measurement order (axillary followed by temporal artery or temporal artery followed by axillary). Temperature pairs were taken once during the day shift and once during the night shift. Behavioral states were assessed before, during, and after temperature measurement. Results: Neonates were predominantly female (64.7%) with a mean age of 6.6 days and a mean gestational age of 32.7 weeks, and most were cared for in incubators (n = 55). Noninferiority was observed between the two temperature methods (Holm-Bonferroni criterion =.025, p <.001). There was no statistically significant difference in the behavioral states of the neonates between the two temperature methods. It took nurses significantly longer to use the axillary thermometer than to use the temporal artery thermometer (p <.001). Conclusion: Temporal artery temperature measurements were as accurate as axillary temperature measurements in low-birth-weight neonates in the NICU. Nurses spent less time measuring with the temporal artery method than with the axillary method.