Background: Almost all neonates develop some degree of hyperbilirubinemia, as a normal transition in their physiology in order to adapt to extrautrine life, and nurses have a vital role in providing care to neonates with hyperbilirubinemia and treated with blood exchange transfusion. Aim of the study: was to assess nurses' performance regarding care of neonates undergoing blood exchange. Design A descriptive research design was used to achieve the aim of this study. Setting This study was conducted at the neonatal intensive care unit affiliated to Beni-Suef university hospital. Sample a purposive sample of 60 nurses were included in the study. Tools: Two tools were used to collect the data. A structured questionnaire sheet and observational checklist format. Results: the study findings showed that 86.6% of the studied nurses were in the age group 20-