We conducted a survey and audit of thermal equipment use in very low-birth-weight infants in five Ohio neonatal intensive care units (NICUs) to document regional practice. The survey indicated a variety of thermal care styles. Two NICUs preferred to admit infants to incubators, the other three favoring radiant warmers. These three NICUs moved infants from radiant warmers into incubators at significantly different mean ages. The audit demonstrated inconsistent use of plastic covers, warming mattresses, and added humidity under radiant warmers, and discrepancies between survey responses and actual use within NICUs. Inter-NICU variability of thermal equipment use may complicate fluid management.