Background: Blood transfusion is used to replenish lost blood components in a number of medical situations. Objective: To identify blood transfusion indications, complications and frequency in Benha neonatal intensive care (NICU). Patients and Methods: This research was carried out on all neonates attended to NICU in Benha University Hospital between January 2022 and July 2022. A number of 173 neonates were admitted to NICU during the study period, 51 (29.5%) of them needed blood transfusion. Results: Neonates who had blood transfusion consisted of 27 males (52.9%) and 24 females (47.1%); their mean gestational age was 32.7±3.1 weeks. The most common causes of blood transfusion in the studied group were anemia of prematurity (29.4%), followed by neonatal sepsis (16.9%). Most cases (49%) received blood transfusion at 7 to 14 days. Neonates who had blood transfusion had statistically higher frequency of mortality and longer duration of hospital stay compared to neonates who didn't have blood transfusion. Multiple linear regression analysis revealed that gestational age, weight, and need of oxygen support are potential predictors for blood transfusion. Conclusion: Rate of transfusion in the newborn unit was 29.5%. The most common causes of blood transfusion in the studied group are anemia of prematurity (29.4%), followed by neonatal sepsis (16.9%). Efforts are required to prevent preterm labour and sepsis, in order to decrease the need for transfusions in neonatal units.