Kernicterus or bilirubin encephalopathy is caused by unconjugated hyperbilirubinemia that develops either as a result of haemolytic process or inability of liver to conjugate bilirubin. It is preventable through the use of phototherapy, intravenous immunoglobulins (IVIg), or exchange transfusion (ET). The exact bilirubin threshold for intervention remains debated, leading to a study focusing on the outcomes of exchange transfusion for high bilirubin levels in term neonates in a NICU setting. Prospective study over 3 years period, carried out in NICU at government teaching institute to determine the outcome and side effects of exchange transfusion and study the neonatal and maternal risk factors resulting in hyperbilirubinemia requiring exchange transfusion. Blood grouping and Rh typing were done for both mothers and newborns. In all newborns, pre-exchange complete blood count, peripheral blood film, coombs test, reticulocyte count, serum bilirubin and post-exchange serum bilirubin, haemoglobin was done. Maternal and neonatal factors, indications, and outcomes were analysed. It was observed that neonates requiring exchange transfusion were mostly term associated more commonly with Rh incompatibility. Exchange transfusion was required among few of the admitted newborns with unconjugated hyperbilirubinemia. The common adverse effect was sepsis. Overall outcome after exchange transfusion was favourable.