Objectives: 1) Screening by otoacoustic emission (OAE), to study the incidence of hearing impairment in newborns; 2) to compare the incidence of hearing impairment in normal to high-risk newborns and 3) to study if the risk of hearing impairment increases as the number of risk factors increase. Material and methods: This was a prospective nonrandomized observational cohort study from November 2011 to December 2013. All newborns born in the hospital were included. Detailed history (pre- and postnatal) of each newborn pertaining to risk factors for hearing loss was taken and a detailed examination was done. Relevant serological tests were done. Newborns were screened for hearing impairment by OAEs and the result of the test was noted as PASS/REFER (FAIL). Results: Overall incidence of hearing impairment in newborns: 1.8%, incidence of hearing impairment in normal newborns: 0.7% and hearing impairment in high-risk newborns: 6.3%. Incidence of hearing impairment was significantly higher in high-risk newborns compared to normal newborns (p < 0.01). Conclusion: Though, the incidence of hearing impairment is significantly higher in high-risk newborns, targeted screening of high-risk newborns will result in missing a significant number of normal newborns with hearing impairment. Hence, there is a necessity for universal newborn hearing screening program.