Objective Our aim was to determine the relationship between red blood cell transfusion and necrotising enterocolitis (NEC) in all admitted very low birth weight (VLBW) infants with or without transfusion. Study Design All VLBW neonates were categorised into five groups: (i) subjects that developed NEC <48?h after transfusion (n?=?15); (ii) subjects that developed NEC >48?h after transfusion (n?=?31); (iii) subjects that were never transfused but developed NEC, (n?=?50); (iv) subjects that were transfused but did not develop NEC, (n?=?250) and (v) subjects that were neither transfused nor developed NEC (n?=?301). Results A group of 647 infants were enrolled in the study. Mean gestational age and birth weight of the patients were 29 +/- 3.1?weeks and 1157 +/- 237?g, respectively. The mean age at the onset of NEC in the NEC groups were 20 +/- 2.3?days, 12 +/- 3?days and 11 +/- 2.6?days, respectively (P?0.05). The mean interval from the last transfusion to the onset of NEC was 16.8 +/- 8.8?h in group 1 and 240 +/- 50?h in group 2 (P?0.05). Conclusion In this study, we sought to evaluate all VLBW infants, whether they received a transfusion or not. We suggest that transfusion associated NEC exists, but many other factors influence this multifactorial disease. The age of NEC onset was later in transfused vs non-transfused patients, whereas the interval between transfusion and NEC was shorter in transfused vs non-transfused patients.