Blood and blood product transfusions are commonly required in the NICU. Recurrent blood transfusions are not without risks. Increased frequency of transfusions was associated with increased incidence of complications and mortality. Aim of the work: The aim of this study was to evaluate blood transfusion practices among admitted neonates to know whether current proceedings are according to the international guidelines and to document complications following those transfusions. Materials and Methods: This prospective observational study was conducted in El Galaa hospital over a period of six months from March to August 2013 on 120 neonates ≥29 weeks gestation who received blood transfusions and had no complications prior to transfusion. Indications and complications of transfusions were documented. Results: Preterm infants represented 90% of cases. The most common indication for transfusions was anemia in 84.6% of cases. By the end of their hospital stay, 55% of babies developed complications. The most common complications documented were late onset sepsis (27.5%), bronchopulmonary dysplasia (15.8%), necrotizing enterocolitis (5.9%) and intraventricular hemorrhage(5.8%). Increased frequencies of transfusions were associated with increased incidence of complications and mortality. Analysis of our results concluded that 57.5% of cases received non indicated blood transfusion according to recent restrictive guidelines, while 12.5% of transfusions should have definitely been avoided. Conclusion: This study shows that strict adherence to international guidelines for transfusion decisions is essential to avoid unnecessary blood transfusions to minimize incidence of complications and mortality.