Objective: To determine the accuracy and precision of transcutaneous bilirubin (TcB) measurements in preterm neonates.Study Design: Neonates were stratified into three groups on the basis of gestational age: 24 to 28 weeks (Group 1, n ¼ 30), 29 to 31 weeks (Group 2, n ¼ 29) and 32 to 34 weeks (Group 3, n ¼ 31). TcB was measured using the Draeger Air Shields JM-103, and when possible, measurements were made by two observers. TcB and total serum bilirubin (TSB) measurements were compared, and interobserver precision for TcB measurements was assessed.Result: Correlations between TcB and TSB ranged from 0.79 to 0.92. Most of the differences between TcB and TSB were ±2 mg per 100 ml, and there was no trend for the difference to increase with increasing bilirubin values. Sensitivity, specificity and negative predictive values ranged from 0.67 to 1.0, 0.29 to 0.81 and 0.60 to 1.0, respectively. Intraclass correlations were 0.87 to 0.92. Conclusion:TcB correlates significantly with TSB in preterm neonates, and interobserver precision is significant. Routine measurement of TcB in preterm neonates may provide enhanced clinical monitoring for hyperbilirubinemia.