Introduction: Neonatal hearing impairment is a critical developmental issue, especially among high-risk newborns, where early detection and intervention can significantly influence speech, language, and cognitive outcomes. Aim: This cross-sectional study investigates the prevalence of hearing impairment in high-risk neonates admitted to the NICU of GMC, Amritsar, from December 2022 to May 2024, focusing on objective screening through Otoacoustic Emission (OAE) and Brainstem Evoked Response Audiometry (BERA) tests. Material and Methods: A total of 180 high-risk neonates underwent OAE screening within the first month, with BERA follow-up at three months for those with "REFER" results. Results and observations: The findings reveal a REFER rate of 29.4% in the right ear and 32.2% in the left ear using OAE, with lower REFER rates in BERA (8.3% in the right ear and 11.1% in the left ear), underscoring the importance of two-stage screening. Prematurity, severe hyperbilirubinemia, extended NICU stays, neonatal sepsis, and mechanical ventilation emerged as significant risk factors for hearing loss. Conclusion: The study highlights the necessity of implementing targeted neonatal hearing screening protocols for high-risk populations to facilitate timely intervention and improve long-term developmental outcomes, aligning with public health objectives to enhance quality of life in affected children.