INTRODUCTION: Significant hearing loss if undetected at birth will impede speech, language and cognitive development. It is important to monitor hearing loss in high risk patients in Neonatal ICU. AIM: To know the prevalence of hearing impairment in high risk newborns admitted in the Newborn ICU in a tertiary care centre in Kerala. MATERIALS AND METHOD : Clinical cross sectional study ,conducted in Department of Otorhinolaryngology and in new born intensive care unit (NBICU) of Government Medical College Hospital, Thrissur, from July 2014 to June 2016. 350 High risk babies were studied. The demographic data and detailed clinical history were also collected. Infants were screened with Oto Acoustic Emissions( OAE). Retest with OAE was done for infants with refer OAE result after one month. Babies whose result was refer again , had undergone BERA(Brainstem Evoked Response Audiometry) diagnostic test 1 month later. Data’s were coded and entered in MS Excel and analyzed using Epi info7 software. RESULTS: The prevalence of Permanent Childhood Hearing Impairement (PCHI) with hearing loss exceeding 40dB in our study is 1.8%. DISCUSSION: The prevalence of hearing impairment in high risk new borns it is 2–4% by previous studies. Our results paralleled with previous studies. Among the risk factors, hyperbilirubinemia and antenatal infections were found to have a strong association. CONCLUSION: In our study,1.8% had hearing impairment. Hence, there is an urgent need to incorporate universal neonatal hearing screening in all the neonatal health care facilities in India.