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Platelet transfusions are frequently given to neonates with platelet counts (PCs) below an arbitrary trigger, 1,2 but studies have shown a poor correlation between low PC and bleeding, 2,3 highlighting the need for better tests to identify infants at risk.Neonates have a unique primary hemostatic system, characterized by hypofunctional platelets counterbalanced by factors that enhance clotting (high hematocrit, mean corpuscular volume, and von Willebrand factor concentrations). 4 Thus, we hypothesized that a global test of primary hemostasis, the Platelet Function Analyzer-100 (PFA-100), an in vitro equivalent to the bleeding time, would be a better marker of moderate to severe bleeding among preterm neonates with thrombocytopenia than the PC. The PFA-100 (Dade Behring) measures the time it takes for blood to occlude an aperture (closure time [CT]) following stimulation with collagen and epinephrine (CT-Epi) or collagen and adenosine diphosphate (CT-ADP). Based on a previous finding that the CT-ADP was better correlated with the PC than the CT-Epi in neonates, 5 we focused on the CT-ADP.