Objective <p>To compare the incidence and severity of skin damage associated with transparent film dressing and microporous paper tape used for temperature probe fixation in preterm neonates.</p> Methods <p>Preterm neonates requiring radiant warmer care were randomized to receive either transparent film dressing or microporous paper tape for temperature probe fixation. Skin integrity at the probe site was assessed using the Neonatal Skin Condition Score (NSCS), which evaluated dryness, erythema, and breakdown. The primary outcome was the proportion of neonates with any skin damage, defined as an increase in NSCS by ≥ 1 point.</p> Results <p>A total of 128 preterm neonates were randomized (64 per group). The proportion of neonates with any skin damage was comparable between the microporous paper tape and the transparent film dressing groups [41/64 (64.1%) vs. 38/64 (59.4%); <i>P</i> = 0.585]. Skin dryness was more frequent in the microporous tape group (54.7% vs. 31.3%, <i>P</i> = 0.007). Incidence of erythema (<i>P</i> = 0.108) and skin breakdown (<i>P</i> &gt; 0.999) were comparable between the groups. The median frequency of total NSCS &gt; 3 threshold exceedance per participant did not differ significantly [0.67 (0, 1.00) vs. 0.33 (0, 1.00); <i>P</i> = 0.590], whereas dryness threshold exceedance was significantly more frequent in the microporous paper tape group [0.33 (0, 0.67) vs. 0 (0, 0.33); <i>P</i> = 0.010]).</p> Conclusions <p>The overall incidence of skin damage did not differ between the study groups. However, microporous paper tape was associated with significantly higher rates of skin dryness, while erythema and breakdown were comparable.</p> Trial registration <p>ClinicalTrials.gov, CTRI/2024/11/076889. <a href="https://clinicaltrials.gov/study/CTRI/2024/11/076889">https://clinicaltrials.gov/study/CTRI/2024/11/076889</a>.</p>