Background: Hearing impairment in children is a hidden disability. By the time, it is recognized usually at 2:3 years. The child's speech and language ability will be irreversibly affected. Early detection of hearing impairment and timely intervention can give better consequences. Objectives: Identification of the most significant risk factors for hearing impairment in high risk neonates hospitalized at our Neonatal Intensive Care Unit (NICU) and to assess the sensitivity of hearing screening tests. Patients and methods: This study was carried out on newborns with risk factor of hearing loss admitted to NICU of Pediatric Department, Zagazig University Hospital from December 2017 to December 2018 using both transient evoked otoacoustic emissions (TEOAE) and Auditory Brainstem Response (ABR) tests in Audiology Unit, Zagazig University Hospital. Number of the studied neonates was 58 high risk neonates. Results: Of the criteria that studied neonates was chosen according to it, exposure to ototoxic medications was the most common risk factor (82.8%) followed by assisted ventilation > 5 days (77.6%), prematurity (62.1%), LBW (56.9%), septicemia (50%), perinatal asphyxia (13.8%). There were statistical significant relationship between auditory brainstem response and ototoxic medications in the studied neonates. Vancomycin and meropenem were significant risk factors of hearing loss. Conclusion: Prematurity, Low birth weight, Septicemia, Perinatal asphyxia and Administration of vancomycin and meropenem were significant risk factors of hearing impairment in our studied neonates by ABR test.