Objective To compare the treatment effects and neurological outcome between intensive phototherapy （IPT） and exchange transfusion （ET） in newborn infants with severe hyperbilirubinaemia. Methods The clinical data of 260 neonates with hyperbilirubinemia conforming to ET criteria were analyzed. The infants were divided into IPT group （n＝111） and ET group （n＝149）. The analyses were based on the intention-to-treat （ITT） principle.The level of total serum bilirubin （TSB） after admission，the duration of critical treatment，the decreasing levels of TSB at 18-hour and 48-hour after hospitalization，duration of phototherapy，hospitalization days and costs，neurological outcomes were compared between two groups. Results There were no significant differences in gestational age，birth weight，gender，mode of delivery and feeding method between the two groups （P＞0.05）. The proportion of patients with hospital age ≤ 72 h and blood incompatibility hemolytic disease in IPT group was lower than that in ET group （P < 0.05）. No significant difference in the highest TSB level between two groups （P＞0.05），while the ET group had higher degree of TSB above the ET threshold than the IPT group （P < 0.05）. The infants in the IPT group had shorter duration of critical treatment （from admission to TSB level below to 50 μmol/L of the ET threshold） than those in the ET group infants （from admission to the end of ET） （P < 0.05）. However，compared with the IPT group，the ET group had faster descent rate of TSB during the period of critical treatment （P < 0.05）. After 18-hour of hospitalization，the decreasing level of TSB in the ET group was more obvious than that in the IPT group （P < 0.05）. There were no significant differences at 48-hour after admission between two groups （P＞0.05）. Compared with the ET group，the IPT group had shorter duration of hospitalization and lower hospitalization costs （P < 0.05）. No differences were observed in the incidences of acute bilirubin encephalopathy and kernicterus between the two groups （P＞0.05）. Conclusion IPT did not increase the incidence of neurological adverse outcomes.?However，due to the selection bias，this study couldn’t provide clinical evidence that IPT can completely replace ET.