Hyperbilirubinemia is common in neonates. The value of exchange transfusion (ET) is recognized. The procedure has some risks and complications. This descriptive observational cross sectional study was done in the Neonatology department during the period of January 2013 to December 2013. Total 62 patients were studied. ET was done in 47 patients. Among 47 patients, 29(61.7%) were male and 18(38.3%) were female. The most common cause of ET was Rh incompatibility (46.8%). In order of frequency, major findings were ABO incompatibility (25.5%), unidentified (14.9%), Sepsis (6.4%), minor blood group incompatibility (4.3%) and others (2.1%) respectively. Mean Serum bilirubin level was 22±5.1mg/dl. Most common complications following ET were anemia (12.7%), Sepsis (10.6%), and omphalitis (6.4%). The overall mortality observed was 6.4%. The majority of the adverse events associated with ET were treatable.