Background : Every newborn presents a reduction in red blood cell count reaching a nadir of about 10 gram per dl around 10 to 12 weeks of age , Which is considered a physiological adaptation to the extra uterine environment. In preterm babies, the reduction of hemoglobin (Hb) is faster and earlier particularly those born before 32 weeks of gestational age, and its minimum value is lower when compared to full-term newborns, the nadir may be as low as 6 grams per dl and reached as early as 4 to 6 weeks of age, this is called anemia of prematurity (AOP).The process is self-limited and its intensity increases the more premature newborns are, thus becoming less physiological. Many mechanisms are involved in anemia of prematurity such as excessive collection of blood samples for laboratory examinations, somatic growth of children, reduced average lifespan of neonatal erythrocytes, small fetoplacental transfusion at birth, and interruption of erythropoietin (EPO) release.Anemia of prematurity is characterized by low reticulocyte counts and inadequate erythropoietin response, for which many premature infants receive multiple blood transfusions, which was the usual known method of treatment in case of very low Hb levels . Blood transfusions depress haematopoiesis in healthy infants with anemia of prematurity (AOP) and stimulate HbF synthesis, graft versus host reaction and predispose to multiple blood born infections , so treatment with EPO and iron (Fe) supplementation is routinely used in premature infants.Erythropoietin (EPO) treatment for anemia of prematurity is still controversial. Large multicentric trials demonstrate that administration of EPO and Fe cannot prevent early transfusions, particularly in very low birth weight newborns and in infants with severe neonatal diseases, but may have some beneficial effect to prevent late transfusions. The aim of EPO and Fe administration should be to avoid new late transfusions in very low birth weight preterm infants or to prevent the first transfusion after the second week of life in the preterm infant with the objective of reducing the number of donors rather than the number of transfusions. Recombinant human erythropoietin (rHuEPO) has efficacy in stimulating erythropoiesis in preterm infants, however the success in the elimination or marked reduction in the need for RBC transfusions has not been definitively demonstrated.Objectives :•The primary objective of this review is to examine the efficacy of erythropoietin in prevention and treatment of AOP guided by hematocrit level and reticulocytic count.•The secondary objective is to highlight the role of erythropoietin in minimizing the frequency of blood transfusions among preterm newborns.PICO Population : Preterm infants < 32 weeks of gestation.Intervention : erythropoietin regardless the dose, and route of administrationComparison : with placebo.Outcome : efficacy of erythropoietin in stimulating the erythropoiesis and reducing the number of blood transfusion among the preterm infant.Search StrategyRandomized controlled trials using erythropoietin in prevention and treatment of anemia of prematurity were taken from the Cochrane Controlled Trials Register, Medline.Selection CriteriaRandomized controlled trials using erythropoietin in management of anemia in preterm infants < 32 weeks were selected for this review regardless the dose and the route of administration.Exclusion CriteriaStudies other than randomized controlled trial.Data Collection and AnalysisTitles and abstracts will be used to select potentially relevant articles.Full text for ambiguous titles or abstracts will be also obtained. The methodological quality of the studies will be assessed by assessing the risk for four types of bias (selection, performance, attrition and detection). Meta-analysis of included trials was performed using RevMan 5.Results : A total of eleven trials were included in this review Met analysis demonstrated significant effect of erythropoietin in management of anemia of prematurity. No significant side effects of erythropoietin occurred.Conclusion : Meta-analysis of achievement of showed significant effect of erythropoeitin in management of anemia of prematurity, as shown by the effect on the reticulocytes and the hematocrit level.