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To assess intestinal and cerebral oxygenation during and after red blood cell (RBC) transfusions in preterms with or without subsequent transfusion-associated necrotizing enterocolitis (TANEC).In preterms of < 32 weeks' gestational age, we measured intestinal and cerebral regional tissue oxygen saturation (rint SO2, rc SO2) and their variabilities using near-infrared spectroscopy during and after transfusions. We compared eight infants who developed TANEC 6 to 48 hours after RBC transfusions with 16 controls.In TANEC infants, rc SO2was lower during and after RBC transfusions than in controls, median (interquartile range) 55% (50-62) versus 72% (65-75), p < 0.01. There were no differences regarding rint SO2. Individual rint SO2and rc SO2ranges were smaller after transfusions in TANEC infants, 28% (9-36) versus 49% (40-65), p < 0.01, and 17% (14-33) versus 36% (26-57), p = 0.01, as was short-term rint SO2variability. For each 10% higher rc SO2, the risk of developing TANEC decreased (odds ratio 0.09; 95% confidence interval 0.01-0.63). The smaller the rint SO2range after transfusion, the higher the risk of developing TANEC.In preterm infants lower rc SO2, but not rint SO2, values during and after RBC transfusions are associated with TANEC. Lower rint SO2and rc SO2variabilities after RBC transfusions may represent a diminished capacity for vascular adaptation, possibly leading to TANEC.