Exchange transfusion is the replacement of blood from newborn infants with elevated bilirubin level in their blood stream with donor blood containing normal bilirubin levels. Newborn infants that experience jaundice, the yellowing of the skin and eyes, have a buildup of bilirubin, a chemical that occurs during red blood cell breakdown, or hemolysis. Exchange transfusion is a therapy developed throughout the 1940s by Louis Diamond and a group of surgeons at the Children’s Medical Center in Boston, Massachusetts. During exchange transfusion, a physician inserts a plastic tube called a catheter through the umbilical vein of the infant to slowly remove infant blood and sequentially replace it with donor blood. Exchange transfusion was the first definitive treatment for hyperbilirubinemia in the US and it helped reduce the incidence of kernicterus, a type of brain damage caused by elevated bilirubin levels.

Neonatal jaundice is the yellow discoloration of the skin and eyes due to elevated bilirubin levels in the bloodstream of a newborn. Bilirubin is a byproduct of the breakdown of red blood cells. Jaundiced infants are unable to process bilirubin at a normal rate or they have an abnormally high amount of bilirubin in their bloodstream, resulting in a buildup of the yellow colored bilirubin. That build up is called hyperbilirubinemia and is the cause of jaundice. Jaundice can lead to kernicterus, a rare neurological disorder that results in hearing loss, permanent brain damage, and sometimes death. Research into the causes of jaundice and kernicterus began in the late eighteenth century in Paris, France. By the middle of the twentieth century, scientists developed treatments for jaundice that successfully treated infants afflicted with the condition, phototherapy and blood exchange transfusion, due to these treatments, the risk for an infant in developing kernicterus is very low.