The conventional treatment includes phototherapy and exchange transfusion. The advantages of the exchange transfusion in the Rh hemolytic disease are well defined but its risks remain high and the mortality rates related to the procedure range around 2% and the morbimortality (thrombocytopenia, thrombosis of the portal vein, necrotizing enterocolitis, metabolic disorders and infection) reach 12%. The procedure requires the availability of compatible blood, a team with appropriate training in the procedure and a neonatal ICU infrastructure prepared to prevent the admission of newborns whose mothers did not go through prophylaxis.