Aim: We investigated myocardial contractility as measured by Echocardiographic parameters of Tissue Doppler Imaging (TDI), Myocardial Performance Index (MPI), Ejection Fraction (EF) and Biochemical markers in VLBW infants before and after red cell transfusion.Method:Prospective, observational study on VLBW infants of < 34 weeks gestation and >2 weeks of age. Blood sampling and echocardiogram performed in 12 hours before and between 3 to 7 days after transfusion. Infants with congenital heart lesions were excluded. Data was analysed using paired t-test, Wilcoxon signed rank and Kendall's Tau to compare the differences and to see correlation between pre and post values.Results: 74 pre and post transfusion (Pst) studies were performed on 28 infants. Pre-transfusion (Prt) haematocrit (Hct) ranged between 0.20% and 0.29%. Significant improvement in each biochemical and echocardiographic parameters were seen after transfusion:TableThere was also a significant improvement in EF, septal and right ventricular contractility as assessed by TDI and MPI.Conclusion: Assessment of myocardial performance by echocardiography and biochemical markers demonstrate significant improvement following transfusion which is not proportional to the severity of the anaemia.