In U.S. programs, about 2–10% of newborns don’t pass the first hearing screen, and most pass a quick rescreen soon after.
Newborn hearing screening happens while your baby is in the hospital or soon after. It’s quick and gentle, picks up issues the eye can’t see. A “pass” means both ears responded in the expected way. A “refer” or “did not pass” means your baby needs another check. One result never labels a child for life; it’s a first filter.
What The Hospital Screen Checks
Hospitals use two tools. Otoacoustic emissions, or OAE, plays soft clicks into the ear canal and measures echoes from the cochlea. Automated auditory brainstem response, or AABR, uses tiny sensors to see if the hearing nerve and brainstem react to sound. Both tools are safe while a baby sleeps. Programs often use one test first, then the other if a baby doesn’t pass before going home.
Each test takes a few minutes per ear. The tester places a small ear tip or adhesive sensors, starts the device, and watches the display. Calm, sleeping babies make cleaner recordings, because motion and noise mask weak signals. That’s why nurses ask you to time feeds so your newborn dozes off right before the screen.
Newborn Hearing Screen Outcomes At A Glance
| Screening Stage | Typical Outcome | What To Do |
|---|---|---|
| Inpatient screen (birth stay) | Most pass; a small share do not | Feed, settle baby, repeat if needed before discharge |
| Outpatient rescreen | Many who did not pass now pass | Return within 1–2 weeks for a repeat |
| Final refer rate | Programs aim <4% after rescreen | If still not passing, book a full diagnostic test |
Why do some newborns not pass on day one? New ears often have fluid or vernix. The room may be noisy. Babies wiggle or wake. A very early test leaves less time for ear canal debris to clear. Rescreening when your baby is calm improves accuracy. The CDC EHDI 1–3–6 guidance also urges quick next steps so families don’t lose time.
How Common Is A “Fail” On The First Test?
Across U.S. programs, a small fraction of babies do not pass their first screen. Rates vary by hospital workflow, timing, and test type. Two figures help frame the picture. First, most states screen well over 95% of babies by 1 month. Second, after the rescreen, programs target a final “refer” below 4% based on national benchmarks. Put together, it’s common to see a few percent flagged on day one, then a sharp drop after the quick rescreen.
Why Babies Don’t Pass On Day One
Middle ear fluid after birth can dampen sound. Vernix or moisture in the ear canal blocks the probe. Background noise or a restless infant can muddy results. Prematurity and time in the NICU can raise the chance of a “refer,” and NICU programs usually screen with AABR to catch nerve pathway issues. None of these findings prove permanent loss; they mark a need for a repeat in a calm setting.
Newborn Hearing Test Failures: How Often Does It Happen?
Think of the screen as a net that errs on the side of caution. Many babies who are flagged early will pass the repeat. Clinicians often quote ranges like 2–10% for the first screen at the hospital, with nine in ten of those passing later. The tiny group that still does not pass needs a full diagnostic exam. That exam shows whether hearing is typical, temporarily blocked, or reduced.
Pass, Refer, And “Could Not Test” — What Each Means
Pass: The device captured stable responses in both ears. Your baby still needs routine hearing checks during childhood, but no extra newborn steps are needed.
Refer: The device did not record a clear response in one or both ears. Book an outpatient rescreen soon. If the rescreen is also not passed, move to a full diagnostic test with a pediatric audiologist.
Could not test: The screen was not finished, often because the baby was awake or equipment wasn’t available. This result is not a pass. Treat it like a “refer” and schedule the repeat quickly.
What To Do After A “Refer” Result
Act fast, and keep the steps simple. Book the outpatient rescreen as soon as you can, ideally within the first couple of weeks. Keep the room quiet, feed your baby before the test, and aim for nap time so your newborn sleeps through it. If your baby still does not pass, schedule a diagnostic visit with a pediatric audiologist by 2–3 months, as the NIDCD guidance explains. Fast moves help you start care sooner if hearing loss is found, and prevent weeks of worry caused by delays.
If you need to travel for the rescreen, ask the clinic about parking and check-in steps so you can arrive with time to feed and swaddle. Bring a bottle or plan to breastfeed on arrival. If your baby only referred in one ear, still keep both appointments, since each ear is tested separately during diagnosis. Save every paper or portal note; that trail helps the audiologist see the full story.
NICU And Well-Baby Differences
Babies who spent time in the NICU have different risks and may show a higher refer rate. Many NICU programs use AABR only, since it checks the nerve pathway along with the cochlea. Some conditions connected with intensive care can affect hearing. That’s why NICU graduates often need closer follow-up even when they pass before discharge.
What The Numbers Mean Over The First Six Months
Screening is only the first step. National EHDI data show strong coverage: more than 98% of U.S. newborns get screened, and the prevalence of confirmed hearing loss is around 1–2 per 1,000 babies screened. Many infants who need more testing never finish the loop, so quick scheduling and clear handoffs matter. The 1–3–6 goals call for screening by 1 month, diagnostic confirmation by 3 months, and enrollment in early intervention by 6 months for babies found to be deaf or hard of hearing.
Timeline And Actions For Families
| Age | Goal | Action |
|---|---|---|
| Birth to 1 month | Complete newborn screen | Attend inpatient screen; return for rescreen if needed |
| By 3 months | Confirm diagnosis | Finish full audiology testing if rescreen not passed |
| By 6 months | Start early intervention | Begin hearing care and family-centered services if eligible |
How Screening Methods Shape Results
A one-stage approach (using only OAE or only AABR) is simple but can trigger more false alarms. Two-stage pathways lower that signal. A common pattern is OAE during the birth stay, then AABR if a baby does not pass. That mix trims early “refers” and still catches nerve-pathway issues before families leave the hospital. Quality programs also track the final refer rate after rescreen, aiming for less than 4%.
Teams also watch for missed appointments, since lost follow-up hides true outcomes. Many programs now text reminders, offer Saturday slots, and coordinate with primary care to keep babies on the timeline.
Risk Factors That Call For Extra Checks
Some babies pass at birth but still need added surveillance because certain risks raise the chance of later changes. Here are common ones clinicians watch:
- A stay in the NICU, especially with assisted ventilation or certain medicines
- Family history of early childhood hearing loss
- Head or face differences involving the ear canal or pinna
- Infection during pregnancy such as CMV
- Severe jaundice requiring exchange transfusion
- Suspected developmental concerns tied to hearing
Babies with one or more of these risks need repeat hearing checks on a set schedule even if they passed as newborns.
How To Prepare For A Repeat Screen
Small steps help the rescreen go smoothly. Time the visit so your baby arrives sleepy and fed. Dress your newborn in a loose-neck outfit so the tester can place sensors with minimal fuss. Bring a swaddle blanket and a pacifier if you use one. Ask for a quiet room, silence your phone, and keep voices low. If your baby wakes and cries, pause, settle, and resume. Calm babies give cleaner results.
Feeding And Sleep Timing
Plan a full feed 15–30 minutes before the appointment. Many babies drift into deep sleep during a burp and swaddle. That window is perfect for placing the ear probe and sensors. If your baby tends to catnap, aim for the longest nap of the day. While you wait, rock gently rather than walking laps, which can rouse a light sleeper.
Quiet Room Setup
Ask the clinic to lower overhead noise and dim the lights. Turn off notification sounds on your phone and avoid conversation near the bassinet. If siblings join, bring a quiet toy and snacks so the room stays calm. A few minutes of stillness can decide whether the device records clean responses on the first pass.
When Hearing Loss Is Confirmed
Some infants will show reduced hearing on the full exam. Your audiologist will explain the type and degree of loss and outline choices. Options can include hearing aids, bone-conduction devices, or cochlear implants for eligible babies. Early intervention coaches families on communication and listening at home. With consistent follow-up, children with hearing loss can develop strong language and connect well with the world around them.
Bottom Line For Newborn Hearing Test Results
A “refer” on the first screen is common enough to be expected, and most newborns who don’t pass at birth pass the repeat. The path is straightforward: rescreen soon, complete the diagnostic visit if needed, and start services early if hearing loss is confirmed. Quick action keeps your baby on track for speech, language, and learning.