Preterm and low birth weight (LBW) infants are believed to have an increased risk of developing bilirubin associated brain damage. The cases of kernicterus are nearly disappearing from the NICU population, possibly because of overall improvements in the care of LBW infants and/or the aggressive use of phototherapy.

Exchange Transfusion and Phototherapy: Exchange transfusions and phototherapy are the key intervention for jaundice in newborns. Phototherapy, if used appropriately, can control the bilirubin levels in nearly all LBW infants, except infants with severe erythroblastosis fetalis or pronounced bruising. 

On contrary, Exchange transfusion at the low bilirubin levels when used for treatment in LBW infants proves to be very inefficient and less effective than phototherapy in achieving a prolonged reduction of TSB in non-haemolytic jaundice infants.

Exchange Transfusion Complications: A serious complication of exchange transfusion, like arrhythmia, thrombosis, thrombocytopenia, necrotising enterocolitis, and infection etc or to die during or soon after the procedure is often reported among Sick, preterm infants than their healthy counterparts.

Source: Maisels MJ, Watchko JF. Treatment of jaundice in low birth weight infants, Archives of Disease in Childhood - Fetal and Neonatal, 2003;88:F459-F463.