Once commonly performed in the NICU, double volume exchange transfusion has become a rare procedure due to the prevention of hemolytic disease of the newborn and changes in detection and management of hyperbilirubinemia. Despite these advances, the procedure remains an important tool in the neonatologist’s armamentarium to reduce bilirubin levels. In this article, the indications, practical considerations, and the technique of exchange transfusion are reviewed to ensure that this skill is not a lost art of neonatology.

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