Introduction: The experience with Infliximab (Remicade; Centocor, Malvern, PA), in pediatric Crohn’s disease (CD) is limited: A high rate of short term response and steroid sparing have been shown. One long-term study showed a 90% relapse rate at 1 yr. Aim: Assessment of the efficacy and safety of long term infliximab treatment. Methods: A multicenter retrospective survey was carried out of all infliximab infusions administered from Jan 1999 to Sep 2003. Medical records of patients aged 1.5 to 18 yrs were reviewed for clinical data and complications. Eligibility for treatment was based on the judgment of the pediatric gastroenterologist. All patients were refractory to conventional therapy or steroid dependent. Infliximab was given by IV infusion at a dose of 5mg/kg over at least 2 h. PCDAI was calculated prior to and periodically during treatment. Results: 36 patients (M=24), aged 14.8±3.0 yrs, received 172 infusions. Disease location was: colonic/ ileocolonic 47%, terminal ileum 11%, extensive 42%. Two patients had fistulizing disease. Four patients underwent surgery for CD before therapy. The mean interval between CD diagnosis and treatment was 3.3±2.7 yrs. All patients received concurrent treatment: 28 immunosuppressive drugs (25 AZA/6-MP, 3 MTX), 8 steroids and 5 received 5-ASA preparations. The mean number of infusions was 4.9±3.3/patient, range 1–15. Length of follow-up was 12.9±9.4 months. The injection schedule was: 2nd infusion within 2–4 weeks from the 1st, and there after every 4–8 weeks. Significant response was observed in 28 patients (78%); 18(50%) complete remission and 10(28%) partial response. PCDAI values decreased from 32.0±10.6 prior to treatment to a minimal value of 15.3±13.8 after treatment (p<0.001). Duration of remission and response was 10±10 months and 11±5.2 months, respectively. Relapse occurred in 14 (50%) patients after 3.1±0.9 injections. Multiple relapses occurred in the majority of patients between infusions, usually responding to shorter infusion intervals. No association between response rate and early or late CD was found. Six patients required surgery after therapy. Infusion reactions occurred in 10 patients; 3 severe and 7 mild/moderate reactions. Conclusion: Infliximab with concurrent immunosuppressive therapy is effective as long term treatment for children with refractory CD. Prolonged systematic re-treatment is often required to overcome the high relapse rate.