Full-term neonates paradoxically have normal to even shorter bleeding, compared to adults. This is likely due to compensatory factors, including high levels of von Willebrand factor (vWF). Platelets in the newborn (neonatal platelets) are known to be hyporesponsive in vitro, compared to adult platelets. Neonatal platelets are also hyper-functional: higher platelet deposition on vWF under shear conditions, compared to adult blood. Most studies are performed in platelets isolated from umbilical cord blood, which are not identical to neonatal platelets from peripheral blood. Thrombocytopaenia (platelet counts <150 × 106/mL) is difficult to define due to high variability in platelet counts described and often it is not linked to bleeding. An abundance of bio-reactive lipids, extracellular vesicles and immune modulatory cytokines are accumulating in platelet components during storage, especially in the smaller paediatric units. In bleeding neonates, to restore haemostasis, more restrictive transfusion policies with higher platelet thresholds of 25 × 106/mL are currently being implemented globally. Restrictive transfusion regimens are leading to less complications without increasing bleeding risk. Other treatments to treat bleeding include repletion of coagulation factors and use of thrombopoietin analogues. Thrombosis is very common in pre-term neonates, especially when this very vulnerable cohort is on extracorporeal membrane oxygenation. Venous thrombosis is very challenging to manage, especially due to a lack of studies in the neonatal patients and differences in aetiology when compared with adults.