The objective of this prospective study was to report on the prevalence of hearing impairment in the neonatal unit population. From 15 February 2000 to 15 March 2000 and from 15 February 2001 to 15 May 2001, 401 neonates were screened using transient evoked otoacoustic emissions (TEOAE) followed by second-stage screening of those infants who failed the initial test. Eight (2 per cent) infants failed one ear and 23 (5.74 per cent) infants failed both ears, adding up to 7.74 per cent planned for second-stage screening. Five out of 22 infants who came for the follow up failed the screening, resulting in a prevalence of hearing impairment of 1 per cent (95 per cent confidence interval [95% CI]: 0.0–2.0). Craniofacial malformations, very low birth weight, ototoxic medication, stigmata/syndromes associated with hearing loss and hyperbilirubinaemia at the level of exchange tranfusion were identified to be independent significant risk factors for hearing impairment, while poor Apgar scores and mechanical ventilation of more than five days were not. In conclusion, hearing screening in high-risk neonates revealed a total of 1 per cent with hearing loss. The changes in the risk profile indicate improved perinatal handling in a neonatal population at risk for hearing disorders.