Background: Almost all newborn infants develop some degree of hyperbilirubinemia as a normal transition in physiology. High levels of unbound unconjugated bilirubin can cross the blood-brain barrier and cause neurological symptoms. Objectives: To determine the frequency of exchange transfusion in neonates with hyperbilirubinemia and to describe the characteristics of neonates with hyperbilirubinemia including those who underwent exchange transfusion. Methods: A retrospective study was conducted to know the frequency of exchange transfusion in neonates admitted to hospital with hyperbilirubinemia and to study selected characteristics of these babies including; sex, gestational age, body weight, type of feeding, and mode of delivery, and to identify the causes of hyperbilirubinemia. Results: A total of 120 neonates were enrolled in the study, 70 males and 50 females. Most of them (67%) were fullterm, weighing more than 2.5 kg. The majority (77%) was delivered vaginally, and mixed feeding with breast and artificial milk formula was the main source of feeding. The mean value of serum bilirubin at time of admission was 14.7 mg/dl and for those underwent exchange transfusion was 22 mg/dl at the time of exchange. In 92 babies (77%), the cause of hyperbilirubinemia was unknown. Hemolytic anemia due to Rh and ABO incompatibility was identified in 16% of babies, and G6PD deficiency was identified in 7%. Exchange transfusion was performed in 16.6% of patients. Conclusion: Although neonatal jaundice is a benign condition in most cases, pathologic harmful hyperbilirubinemia can occur, and despite the benefits of phototherapy, exchange transfusion is still performed and kernicterus is still occurring. Recommendation: Newborn babies should be screened for hyperbilirubinemia and correctly managed to reduce the frequency of exchange transfusion which carries many risks for newborns, and to prevent kernicterus.