The use of recombinant erythropoietin has been shown to decrease the requirement for transfusion of packed red blood cells (PRBC) in preterm infants. However, the population of preterm infants who would most likely benefit from this therapy has yet to be determined. In order to investigate which infants require the most transfusions of PRBC during their hospital course we retrospectively reviewed our data base for two years (7/93-7/95), all infants < 1500 grams who were offered intensive care were included in the analysis, n=221. A multivariate linear regression model was constructed to determine which clinical factors were most predictive of the need for PRBC transfusion. All data is expressed as mean ± SD. The overall requirement for transfusion was 3.5±4.0 transfusions per infant/hospital course (range 0-20). The number of days of mechanical ventilation(p<.0001), and nasal cpap (p<.0001), birth weight (p<.0001), the diagnosis of sepsis (p<.0001), and bronchopulmonary dysplasia (BPD)(p<.03) and the use of dopamine (p<.001) all independently correlated with the number of PRBC transfusion using forward stepwise linear regression. The overall model was strongly predictive of the number of PRBC transfusions(r=0.9, p<.001). Gestational age, gender, Apgar scores at 1 and 5 minutes, the use of surfactant, caffeine or dobutamine, intracranial hemorrhage, necrotizing enterocolitis, apnea, maternal age, method of delivery, prenatal steroids or MgSO4, chorioamnionitis, oligohydramnios, or urinary tract infection were not related to the number of PRBC transfusion. In our population, infants with the lowest birth weight, and those infants who require prolonged respiratory support, have BPD or sepsis and require dopamine received the most transfusions of PRBC. We speculate that recombinant erythropoietin would lead to the greatest reduction in the number of PRBC transfusions when given to infants with the lowest birth weight, with BPD or prolonged need for respiratory support. Further investigation is needed to determine how to effectively deliver recombinant erythropoetin to this population of preterm infants.