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To investigate the importance of transfusion practice with packed red cells (PRCs) in premature infants and to identify risk factors significant influencing transfusion practice, we analyzed 75 preterm infants (gestational age: 31 +/- 2 weeks; birth weight: 1459 +/- 402 g) admitted to the neonatal intensive care unit of Catholic University of Rome. Fifty-three (70.7%) of the infants received one or more PRCs transfusions (in total 246 transfusions). The variables associated with an increase in number and frequency of PRCs transfusions were: a) gestational ageor = 30 weeks; b) birth weightor = 1000 g; c) severe neonatal pathology (ie a respiratory disease requiring ventilatory support and/or a clearly documented or suspected sepsis). Repeated PRCs transfusions during the first week of life significantly (p0.01) influenced the need for late transfusions, after 4 weeks of age, for the treatment of the anemia of prematurity. These data indicate that preterm infants with a gestational ageor = 30 weeks, a birth weight1000 g and a severe respiratory or infectious disease represent natural candidates for administration of recombinant human erythropoietin to reduce the need for late PRCs transfusions.