Abstract. OBJECTIVE: To investigate the association of PRBC transfusion and the development of NEC in VLBW preterm infants at a tertiary care neonatal unit. METHODS: A retrospective case-control study was performed. All VLBW infants (gestational age ≤32 week and birth weight <1500 g) born between 1999 and 2013 were included. Cases and controls were divided into four groups: (1) Infants who received PRBC transfusion and developed NEC within 48 hours of transfusion; (2) Infants who received PRBC transfusion and did not develop NEC; (3) Infant who developed NEC and did not receive PRBC transfusion; and (4) Infants who neither developed NEC nor received PRBC transfusion. Our primary outcome was the association of PRBC transfusion with the development of severe NEC. RESULTS: One hundred fifty two VLBW infants were enrolled. The mean birth weight of enrolled infants was 1042 g and a mean gestational age of 28 weeks. The included four groups were not statistically different with regard to baseline important variables. Infants who had NEC and received PRBC transfusion (group 1) had higher incidence of sepsis and severe retinopathy of prematurity. Overall, Infants who received PRBC transfusion had a lower incidence of NEC (OR 0.39, 95% CI: 0.18,0.84, p = 0.02). CONCLUSION: We observed a lower association of PRBC transfusion and severe NEC in VLBW infants. Prospective, randomized well powered studies are needed to confirm our findings.