We studied the value of transcutaneous carbon dioxide (PtcCO2) monitoring during neonatal transport. Thirty-two neonates with respiratory distress were alternately enrolled in an experimental group (results of PtcO2 and PtcCO2 available for clinical management) and a control group (results of only PtcO2 available). Although differences were not significant, infants in the experimental group had more changes in the intermittent mandatory ventilation (IMV) settings during transport, and more such infants arrived at the receiving hospital with acceptable pH and PCO2 values. On arrival at the receiving hospital, two patients in the control group had acidosis and hypercarbia and were placed on IMV immediately on arrival. No such patients were encountered in the experimental group. For patients needing IMV during transport, the percentage of study time spent with PtcCO2 measurements in the normal range (35 to 45 torr) was greater for the experimental group (p less than .02). Continuous PtcCO2 monitoring during transport offers the opportunity to further decrease the risks of transporting a critically ill neonate.