To estimate the incidence of blood exchange and determine causes and complication of blood exchange and identify strategies for risk reduction of Kernicterus in newborn with jaundice. From March 2004 to March 2006 in neonatal Department in children hospital, medical center Tehran, Iran, 346 neonates were admitted as neonatal jaundice without sign and symptoms of infections. We identified causes and complications of exchange. Of 346 infants with jaundice who received phototherapy. 50, 14.45 percent cases underwent exchange transfusion with mean age 9.38 + 5.75 days. The mean total Serum bilirubin level was 29.39 + 6.13 mg/dl. ABO incompatibility was the most common cause for hyperbilirubinemia. The incidence of apnea was 12% there was no direct death from exchange transfusion. To make payment women aware to observe jaundice regularly after birth of their child and short breast feeding to control dehydration.