Newborn hearing screening results come back as either “pass” or “refer.” A pass means your baby’s hearing appears to be within normal limits. A refer means the screening couldn’t confirm normal hearing in one or both ears, and your baby needs further testing. Hospitals deliberately avoid the word “fail” because a refer result doesn’t mean your baby has hearing loss.
What “Pass” and “Refer” Actually Mean
A “pass” result means the structures of the ear tested are working normally based on the screening equipment’s standards, and hearing sensitivity is likely within normal range. On most printouts, you’ll see “pass” listed next to each ear individually, so your baby’s results will show a status for the left ear and a separate status for the right ear.
A pass isn’t a guarantee of perfect hearing. It’s possible for an infant to have a mild hearing loss that falls below the screening’s detection threshold. Hearing can also change over time due to progressive or conductive hearing loss, which is why pediatricians continue to monitor speech and language milestones at well-child visits.
A “refer” result means the screening could not confirm that hearing is adequate in that ear. It is not a diagnosis. The recommended language hospitals use is: “Your baby didn’t pass the hearing screening, which means more information is needed about your baby’s hearing.” Staff are specifically trained not to tell parents “the baby failed” or “the baby has a hearing loss,” because neither statement is accurate at this stage.
One Ear vs. Both Ears
Your results sheet will show one of three outcomes: pass in both ears, refer in one ear (unilateral), or refer in both ears (bilateral). Each carries a different level of concern and a slightly different follow-up path.
A unilateral refer means one ear passed and the other didn’t. This still requires a follow-up evaluation to determine whether hearing in that ear is truly reduced or whether something temporary, like fluid, caused the result. If a hearing loss is confirmed in one ear, an audiologist will plan ongoing monitoring because unilateral hearing loss can sometimes progress.
A bilateral refer, where both ears didn’t pass, is treated with more urgency because hearing in both ears is essential for speech and language development. The next steps are the same (a diagnostic appointment with an audiologist), but the timeline matters more.
The Two Types of Screening Tests
Hospitals use one or both of two screening technologies, and you may see their abbreviations on your results sheet.
- OAE (Otoacoustic Emissions): A tiny probe placed in the baby’s ear canal plays soft sounds and measures the echo that comes back from the inner ear. Healthy inner ear hair cells produce a faint sound in response to stimulation. If the probe detects that echo, the ear passes. This test specifically evaluates how well the inner ear (cochlea) is functioning.
- AABR (Automated Auditory Brainstem Response): Small sensors placed on the baby’s head measure electrical brain activity in response to clicking sounds played through tiny earphones. This test checks both the inner ear and the nerve pathway carrying sound signals to the brain. It’s less affected by fluid or debris in the ear canal than OAE.
Some hospitals screen with OAE first and use AABR as a second step if the baby doesn’t pass. Others use AABR alone. If your results mention both tests, it typically means the first screening triggered a second one. A refer on AABR is generally considered more clinically significant because it evaluates a broader portion of the hearing pathway.
Why Many “Refer” Results Are False Positives
A refer result is far more common than actual hearing loss. During pregnancy, the middle ear is filled with amniotic fluid, and newborns often still have residual fluid in the middle ear cavity shortly after birth. This fluid, along with remnants of tissue called mesenchyme or even meconium, can temporarily block sound transmission and cause the screening to register a refer. It has nothing to do with the baby’s actual hearing ability.
Other common reasons for false positives include the baby being fussy or moving during the test, ambient noise in the room, a developing auditory system that hasn’t fully matured in the first hours of life, and debris like vernix in the ear canal. One study found that 30% of all newborns did not pass their initial screening, a number far higher than the roughly 1 to 3 per 1,000 babies ultimately diagnosed with permanent hearing loss. The vast majority of babies who get a refer result turn out to hear normally.
Timing matters too. Screenings performed very soon after birth are more likely to produce false positives because fluid hasn’t had time to drain. If your baby was screened within the first few hours, a refer result is especially likely to be temporary.
The Follow-Up Timeline
National guidelines from the Joint Committee on Infant Hearing set clear benchmarks known as the 1-3-6 rule: screening should be completed by 1 month of age, a diagnostic evaluation by 3 months, and enrollment in early intervention (if needed) by 6 months. States that consistently meet these targets are encouraged to aim even earlier, at 1-2-3 months.
If your baby received a refer result in the hospital, the first step is usually a repeat screening within two to four weeks. Many hospitals schedule this before you’re discharged. If the repeat screening also comes back as a refer, the next step is a full diagnostic evaluation with a pediatric audiologist. This is a more detailed assessment than the initial screen and can determine whether a hearing loss exists, what type it is, and how significant it is.
The diagnostic appointment uses more precise versions of the same technology (a full ABR rather than the automated version) along with additional measurements. For infants, the test is usually done while the baby sleeps naturally. The audiologist will explain results in terms of what your baby can and cannot hear across different pitches and volumes.
Reading the Printout
The exact format of your results depends on the equipment your hospital uses, but most printouts include a few standard elements. You’ll see the test type (OAE, AABR, or both), the result for each ear listed separately, the date and time of the screening, and sometimes a waveform or graph.
For OAE results, the printout may show a graph with frequency (pitch) on one axis and signal strength on the other. Peaks rising above a baseline indicate the inner ear produced a response at that frequency. If the peaks are absent or too small, the ear didn’t pass at those frequencies.
For AABR results, you’ll typically see a simple pass or refer for each ear. The equipment’s algorithm analyzes the brainwave pattern automatically, so there’s less to interpret visually. Some printouts include a confidence level or a number of attempts, which shows how many times the test was run before reaching a conclusion.
If anything on the printout is unclear, your baby’s pediatrician or the hospital’s audiology department can walk you through it. The single most important piece of information is whether each ear says pass or refer, and if it says refer, whether a follow-up appointment has been scheduled.