Objective: This study was designed to assess red blood cell (RBC) transfusion frequency in very-low-birth-weight (VLBW)infants and to understand the relationships between the number of transfusions and the composite risk of bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and mortality. Method: VLBW infants admitted from May 2017 – July 2019 were retrospectively analyzed. Relationships between gestational age (GA), birth weight (BW), numbers of transfusions, and comorbidities were evaluated through Pearson correlation analyses. The relationship between factors of interest (Model 1: GA, BW, comorbidities; Model 2: number of transfusions) and composite risk was assessed via a logistic regression approach. Results: Overall,408 VLBW infants were enrolled, of whom 74% underwent at least one RBC transfusion. Infants with a GA<30 weeks, a BW<1,250 g, and comorbidities were more likely to require RBC transfusion. Number of transfusions was related to the risk of analyzed composite outcomes, with risk correlating with undergoing >3 transfusions (OR: 3.275, 95% CI: 1.707–6.275). Conclusion:We found that undergoing > 3 RBC transfusions was related to an increased risk of BPD, ROP, or death in VLBW infants.