Severe jaundice (serum bilirubin level > 340 gmol/L) occurred in 81 infants admitted to the Neonatal Intensive Care Unit (NICU) of the Maternity Hospital Kuala Lumpur (MHKL) in 1993. Of these 46 (56.8%) underwent 53 exchange transfusions. In-patient case notes were available for study on 41 of them. Two infants had no cause identified while 12 were associated with prematurity, 13 ABO incompatibility, 8 G6PD deficiency, 6 sepsis 2 Rh isoimmunisation and 6 miscellaneous causes. In 14 infants it was felt that exchange transfusions might have been avoided if they were detected earlier and phototherapy instituted promptly. Twenty six (26) infants were deemed to have been given phototherapy at the appropriate time but jaundice increased to exchange transfusion levels, threshold values depending on the unit in charge. Use of higher intensity phototherapy might have been more effective in some of the cases. Available data showed similar outcomes in both groups.