Objective: To determine the proportion of neonates with referral result on testing with transient evoked otoacoustic emission (TEOAE) and the associated risk factors. Method: Prospective evaluation of all neonates born in the Hospital within 6 months using the TEOAE. A hand-held Etymotic Research Otoacoustic Emission Scanner (Ero-scan Combo) was used with the child sleeping in the cot or the mother’s hand. Right and left ears were tested separately and the result was displayed automatically as “pass” when 100% of the in-built criteria were met and “refer” if otherwise. The subjects that passed in both ears were regarded as passes, while those with a refer in either the right/left ears or both ears were regarded as referrals and were thus subjected to rescreening in six weeks or on discharge from the special care baby unit. Analysis was done to find association between the outcome of TEOAE and the clinical and epidemiological risk factors. Result: TEOAE was carried out on 386 neonates, (194 males (50.3%) and 192 females (49.7%)). The mean age at screening was 2.3 days (SD = 1.5), the mean gestational age was 38.0 weeks (SD = 2.7) while the mean birth weight was 2.9 kg (SD = 0.7) and the mean Apgar score at 1 and 5 minute were 8.3 (SD = 1.0) and 9.8 (SD = 0.6). At the first step hearing screening, referral rate was 112 (29.0%); at the second stage, 31 (8.5%) neonates had referral in one or both ears. Fisher’s exact test showed that prematurity, multiple births, jaundice and small birth weight were significantly associated with a referral outcome. However, logistic regression revealed prematurity as a significant predictor of referral outcome with a negative predictive value of 12.61. Conclusion: The referral rate is high with prematurity as a significant predictor. This study calls for commencement of newborn hearing screening and strengthening of the public health measures in the developing countries.