Less frequently, when neonatal jaundice is more severe, and ultraviolet light therapy is unable to break down all circulating bilirubin, exchange transfusion is often used. High levels of bilirubin in the blood can lead to brain damage and other serious problems. In these cases, exchange transfusion is a life-saving procedure designed to counteract the effects of serious jaundice, infection, or toxicity. The procedure involves the staged removal of the infant's blood and replacement with fresh donor blood or plasma.

Guidelines for an exchange transfusion include:

• hemolytic disease of the newborn (Rh disease)
• life-threatening infection
• severe disturbances in body chemistry
• toxic effects of drugs
• polycythemia

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