Objective To analyze the risk factors for preoperative coagulation dysfunction in neonates and provide clinical reference for perioperative anesthesia management. Methods Total of 217 Clinical data were collected from neonates requiring surgery in the Neonatal Department of Shanghai Children's Hospital from January 2015 to March 2023. The neonates were divided into the abnormal coagulation function group (41 cases) and the normal group (176 cases) according to whether the coagulation function was abnormal before surgery. The clinical data of the two groups were compared, and variables with statistically significant differences between the two groups were included in the multivariate logistic regression analysis. We also analyze the independent risk factors for coagulation dysfunction in neonates, with the Hosmer‑Lemeshow test used to evaluate the model's goodness of fit. Results Compared with the normal group, the abnormal group had a low gestational age at birth, low age at surgery, and low body weight (all P<0.05). Additionally, in patients of the abnormal group, platelet counts were lower (all P<0.05), and the proportion of preoperative neonatal pneumonia was higher than the parameters of patients in the normal group (P<0.05). Multivariate logistic regression analysis showed that low gestational age at birth [odds ratio (OR) 4.470 (95% confidence interval (CI) 1.693,11.802), P=0.003] and young age at surgery [OR 2.242 (95%CI 1.009,4.984), P=0.048] were independent risk factors for preoperative coagulation dysfunction in neonates. The Hosmer‑Lemeshow test showed that the model had a good fit. Conclusions Gestational age at birth and age at surgery are associated with preoperative coagulation dysfunction in neonates. Improving coagulation function before surgery may play a positive role in reducing the risk of intraoperative bleeding in neonates.