Exchange transfusion is performed using many different combinations of blood components. No single component is unequivocally the best. The purpose of this study was to determine the efficacy and adverse events of exchange transfusion (ECT) with whole blood and reconstituted blood in neonatal hyperbilirubinaemia.The medical charts of all neonates who had undergone ECT over a two-year period were retrospectively reviewed. The demographic features, causes of jaundice, details of the exchange method and ECT-related adverse events of the infants were recorded. A total of 107 ECT procedures were performed in 92 neonates during the study period. The neonates were categorised into those who received whole blood (n is 38) and those who received reconstituted blood (n is 54) for ECT.There was no significant difference in the demographic characteristics and causes of jaundice between the two groups. ABO blood group incompatibility was the most common cause of hyperbilirubinaemia in both groups. The mean pre-ECT haematocrit of exchange transfused patients with whole blood and reconstituted blood was compatible. Although the mean post-ECT haematocrit in the reconstituted group was higher (39.74 +/- 5.65 versus 38.21 +/- 3.59), this difference was not significant (p is 0.15). The mean post-ECT platelet count was 59,000 +/- 29,400 and 73,000 +/- 21,300 in patients who underwent ECT with reconstituted and whole blood, respectively. A similar number of patients in both groups experienced hypocalcaemia and thrombocytopaenia after ECT. No case of ECT-related mortality was observed.ECT with either reconstituted or fresh whole blood is an efficient and safe method for reducing hyperbilirubinaemia.