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Objective: To investigate the acute effects of red blood cell transfusion on haemodynamics in preterm babies.Setting: A neonatal unit in a University Hospital.Patients: Preterm babies whose postnatal age was less than four weeks and who required red blood cell transfusion.Measurement: Cardiac output and left ventricular systolic function was determined using Doppler echocardiography before, one hour and 24 h after red blood cell transfusion. Blood pressure and haematocrit were also recorded at the same time. Mixed-effects regression model was used to analyse the effect of blood transfusion on left ventricular function and cardiac output.Results: 57 preterm babies were recruited. Univariate analysis showed that cardiac index decreased significantly 24 h after transfusion (P<0.05). Systemic red cell transport increased by an average of 11.1% 24 h after transfusion (P<0.05). Multivariate analysis showed that the cardiac index was negatively associated with haematocrit and the index was higher in male babies.Conclusion: There was a significant drop in cardiac index and an increase in systemic red cell transport 24 h after transfusion in premature babies. [ABSTRACT FROM AUTHOR]