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Objective: To assess intestinal and cerebral oxygenation during and after red blood cell (RBC) transfusions in preterms with or without subsequent transfusion-associated necrotizing enterocolitis (TANEC)., Study Design: In preterms of < 32 weeks' gestational age, we measured intestinal and cerebral regional tissue oxygen saturation (r int SO 2 , r c SO 2 ) and their variabilities using near-infrared spectroscopy during and after transfusions. We compared eight infants who developed TANEC 6 to 48 hours after RBC transfusions with 16 controls., Results: In TANEC infants, r c SO 2 was lower during and after RBC transfusions than in controls, median (interquartile range) 55% (50-62) versus 72% (65-75), p  < 0.01. There were no differences regarding r int SO 2 . Individual r int SO 2 and r c SO 2 ranges were smaller after transfusions in TANEC infants, 28% (9-36) versus 49% (40-65), p  < 0.01, and 17% (14-33) versus 36% (26-57), p  = 0.01, as was short-term r int SO 2 variability. For each 10% higher r c SO 2 , the risk of developing TANEC decreased (odds ratio 0.09; 95% confidence interval 0.01-0.63). The smaller the r int SO 2 range after transfusion, the higher the risk of developing TANEC., Conclusion: In preterm infants lower r c SO 2 , but not r int SO 2 , values during and after RBC transfusions are associated with TANEC. Lower r int SO 2 and r c SO 2 variabilities after RBC transfusions may represent a diminished capacity for vascular adaptation, possibly leading to TANEC., Competing Interests: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)