Newborn Hearing Screening

What the newborn hearing screen (AABR) tests for, what a 'refer' result means, and the pathway if more testing is needed.

Last reviewed: Reviewed 2026.05.18
Sources cited: 6 sources
Author: Dr Jubal John, FRACP
Category: medical guides

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Take-home

Every baby in Victoria is offered a newborn hearing screen (AABR) before leaving hospital, through the Victorian Infant Hearing Screening Program (VIHSP). Only around 0.8% of babies “refer” on the first screen in Victoria (VIHSP 2015–2020), well below the international benchmark of 4%, and most of these hear perfectly well on repeat. A “refer” result is a flag for more testing, not a diagnosis. For the small number of babies with genuine congenital hearing loss (around 1–2 per 1,000 newborns), early detection before 6 months leads to language and developmental outcomes similar to hearing peers.

The pathway, at a glance

"Refer" does not mean your baby has hearing loss. Fluid in the middle ear, background noise, or a restless baby can all cause a false refer. Most babies pass on repeat.

Pathway based on the Victorian Infant Hearing Screening Program (VIHSP). Other Australian states follow an equivalent Newborn Hearing Screening Program.

Each state runs an equivalent program (SWISH in NSW, Healthy Hearing in Queensland, etc.). The mechanics are the same.

How the screen works

The test is called AABR: Automated Auditory Brainstem Response. Small, soft sensors on baby’s head and soft earphones in the ears play clicks. A computer measures the brain’s automated response and prints a pass / refer result.

Painless: baby usually sleeps through it
Takes 10–20 minutes per ear
Non-invasive, no blood, no needles
Ideally done before hospital discharge or within the first weeks if home birth

Before discharge or after?

Hospital births: usually before you leave
Home births / early discharge: arranged through your midwife or local VIHSP screening centre within the first few weeks
NICU / SCN babies: screened before discharge with a slightly different protocol (more sensitive, given their higher risk of hearing loss)

Understanding the result

“Pass”

Both ears respond as expected. Your baby moves to routine MCH hearing checks at each nurse visit through the first 5 years. No specialist follow-up needed.

“Refer” on first screen

This is the one most parents worry about, but refer rates on the first screen are low (around 0.8% in Victoria per VIHSP 2015–2020), and most babies pass the repeat screen a few weeks later. Common innocent causes:

Fluid in the middle ear (common in the first 48 hours)
Vernix or debris in the ear canal
Background noise during the test
Unsettled / active baby producing electrical interference

A repeat screen is arranged within 4 weeks. If both ears pass, your baby moves to the routine pathway.

“Refer” again on repeat

If the repeat screen still refers, you’ll be offered diagnostic audiology with a paediatric audiologist. This uses more detailed tests:

Diagnostic ABR (longer, stimuli-varied)
Otoacoustic emissions
Tympanometry to check middle-ear fluid

Diagnostic audiology, the point

The diagnostic test is where a type and degree of hearing loss is defined, if any. Most babies who reach this step still have normal hearing; the rest get a clear picture of what’s happening and an early-intervention plan. Hearing Australia supports eligible children with hearing devices under a government-funded program.

Why we screen so early

Hearing is the foundation of spoken language. Children identified with hearing loss before 6 months, with appropriate early intervention (hearing aids, cochlear implants where appropriate, Auslan / signed-English immersion), achieve language outcomes close to hearing peers by school age. Children identified after 2 years typically carry significant language delay into school.

The cost is a few percent of families going through a repeat screen they didn’t need. The benefit is life-changing for the small number with true hearing loss.

Risk factors that warrant extra watchfulness

A pass on the newborn screen is reassuring but not a lifetime guarantee. About 10% of congenital hearing loss is late-onset or progressive. Keep an eye on hearing if your baby has:

Family history of permanent childhood hearing loss
NICU admission > 5 days
Congenital infection: CMV, rubella, syphilis, toxoplasmosis, herpes
Craniofacial anomalies
Chromosomal conditions (e.g. Down syndrome)
Severe jaundice needing exchange transfusion
Meningitis in infancy
Ototoxic medications (some antibiotics, chemotherapy)

Any of these → bring any concerns forward rather than wait for the next MCH visit.

Milestones: hearing and language

Ages and what to expect

Newborn: startles to loud sudden sounds, calms to familiar voices
3 months: turns toward sound, coos, smiles at your voice
6 months: turns head to locate sounds, babbles (“ba”, “da”), responds to own name
9–12 months: babbles in strings, responds to “no”, says first word-ish sounds
18 months: points to familiar things when named, says 10–20 words, follows simple commands
2 years: 2-word phrases, follows 2-step instructions

If any of these milestones are significantly delayed, book a hearing and language review regardless of the newborn screen result.

When to seek help

Green — usually fine

Green: normal pathway

Passed newborn screen at hospital or first weeks
Hitting sound/language milestones
Responds to name by 6 months

Amber — be alert

Amber: book a review

“Refer” on newborn screen, haven’t had a repeat yet
Seemingly doesn’t turn to familiar voices by 3 months
Not babbling by 9 months
Speech not developing by 18 months
History of ear infections + speech slowing

Red — act now

Red: seek same-day / urgent review

Previously responsive baby has suddenly stopped responding to sound
After loud-noise or head-trauma event, concerns about hearing
Any risk factor above + new concern

Common questions

“If my baby ‘referred’, does that mean they’re deaf?”

No. “Refer” just means the screen couldn’t confirm a clear response on that occasion. The majority of babies who refer on the first screen pass on repeat. Until the repeat (or diagnostic) test is done, there is no diagnosis.

“How long until the repeat?”

Usually within 4 weeks. Try to go sooner rather than later, fluid tends to clear, and getting a clean result is reassuring.

“My baby seems to hear me: surely the screen is wrong?”

Parents are tuned to their own voices and big sounds, and babies often respond to other cues (light change when the door opens, your face, vibration). The screen tests softer sound at specific frequencies, it can detect hearing loss that’s not obvious at home.

“Do I need to avoid noise?”

Normal household noise is fine. Avoid holding a baby close to loud speakers, concerts, or prolonged power-tool use. If you’re using a noise machine for sleep, keep it below 50 dB and at least 2 metres from the cot.

“Is there anything I do that protects hearing?”

Vaccinate on schedule (fewer meningitis-related hearing losses)
Avoid smoking around baby (otitis media / glue ear is more common in smoke-exposed homes)
Treat ear infections promptly

Got a 'refer' result on the newborn screen?

The repeat is usually reassuring. We can help talk through next steps or coordinate a diagnostic slot.