Neonatal exchange transfusion (NET) has a very special place in the history of newborns with severe hyperbilirubinemia (SHB) who are at risk for kernicterus, and other neurodevelopmental problems. NET’s primary indication was and has been the hemolytic disease of the newborn (HDN),which is less common now due to the universal screening for iso-sensitization and also because of appropriate use of antenatal anti-Rh D antibody prophylaxis. In this review, an attempt is made to describe the historical perspective, indications, complications, procedural variations, NET trend, and current status along with future perspective.