https://www.ijnmr.net/back_issues.aspx IJNMR Prakash Chandra Joshi, Bindiya Verma, Niranjan Kumar Singh, Sachin Verma <b>Introduction:</b> Hearing impairment is one of the most common congenital disorders and can significantly affect speech, language, and cognitive development if not identified early. Universal newborn hearing screening plays a vital role in early diagnosis and intervention. However, data on neonatal hearing loss from developing countries, including India, remain limited. <b>Aim:</b> To determine the prevalence of screen positive hearing impairment among neonates attending a tertiary care hospital using Automated Auditory Brainstem Response (AABR) and its association with demographic variables and risk indicators. <b>Materials and Methods:</b> This prospective observational study was conducted at a tertiary care hospital in Northern India from September 2023 to August 2025. A total of 404 neonates were screened using a two-stage AABR protocol. Neonates who failed or had an aborted first-stage AABR underwent second-stage AABR screening. Those who failed the second stage were referred for diagnostic Brainstem Evoked Response Audiometry (BERA) at three months of age. Chi-square test was used to determine the association between different factors and outcomes. <b>Results:</b> Of the 404 neonates screened, AABR testing was aborted in 2 (0.5%), 62 (15.35%) failed, and 340 (84.15%) passed the first-stage screening. Of the 64 neonates who failed or had aborted tests, 37 underwent second-stage screening. Only 3 (8.11%) passed the second- stage AABR, while 34 (91.89%) failed. Overall, hearing impairment was detected in 34 neonates by two-stage screening, giving a prevalence of 8.42%, while the prevalence of confirmed hearing impairment was 0.74% (3/404). The association between neonatal morbidity and hearing abnormalities was highly significant (p-value <0.001). <b>Conclusion:</b> The prevalence of screen positive hearing impairment observed in this study (8.42%) was higher than that reported in Western literature but comparable to that in recent Indian studies. Poor follow-up compliance remains a major challenge in implementing universal newborn hearing screening programs. Strengthening follow-up mechanisms and ensuring early intervention for screen-positive neonates are essential to reduce the burden of childhood hearing loss. https://ijnmr.net/article_fulltext.aspx?issn=0973-709x&year=2026&month=April&volume=14&issue=2&page=PO01-PO05&id=2473 https://doi.org/10.7860/IJNMR/2026/87327.2473