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The optimal level of fibrinogen to aim for is uncertain. The author's approach would be to aim initially for fibrinogen >1?g��dl?1; however, if severe bleeding continues, higher values (>2?g��dl?1) are aimed for. There are large discrepancies between methods of fibrinogen measurement, which may be greater in neonates [6]. Both cryoprecipitate and fibrinogen concentrates can be effective in increasing fibrinogen concentration. The availability of both agents varies from country to country. While cryoprecipitate provides factor VIII, von Willebrand's factor, and factor XIII in addition to fibrinogen, the clinical importance of these is unclear. Cryoprecipitate may produce undesirable effects due to infusion of other plasma proteins (principally immunoglobulins) absent from concentrate. Despite small studies, there is not convincing evidence of selleckchem superiority of either agent [43-45]. A major driver for use of fibrinogen concentrates is logistical. Large patients will require 12�C16?units of cryoprecipitate. This is less of an issue with neonates, in whom a single unit will usually produce a useful increase in fibrinogen concentration. Antifibrinolytic drugs have been shown to reduce bleeding in children and adults [46-48]. While the fibrinolytic system CAPNS1 in neonates has lower activity, large rises in d-Dimer concentration (indicating fibrinolysis) can be demonstrated in situations such as cardiopulmonary bypass. Plasmin may increase bleeding by other mechanisms: breakdown of fibrinogen, cleavage of platelet receptors [49], interaction with inflammation [50], and possibly by breakdown of other procoagulant proteins [51]. The products of fibrin breakdown may also exert anticoagulant effects, principally by interfering with polymerization of fibrinogen. Drugs, which reduce fibrinolysis, have the potential to not only reduce bleeding but to confer additional benefits by reducing inflammation. Over 2000 children have been recruited to controlled Dolutegravir concentration trials of antifibrinolytic drugs during cardiac surgery. It is not possible to identify neonatal patients in many of these reports; however, it appears unlikely that more than 50 of these patients were neonates. In particular, very few neonates (probably