Prematurity is a recognized risk factor for neonatal hearing impairment, but its independent contribution may be difficult to distinguish from coexisting neonatal morbidities and intensive-care exposures. This study aims to assess the association between prematurity and abnormal hearing-screening outcomes and to describe the distribution of abnormal outcomes according to selected perinatal risk factors. This retrospective observational study included 349 participants who underwent otoacoustic emissions and/or auditory brainstem response testing. Participants were classified according to gestational age at birth as preterm (<37 completed weeks) or term (≥37 completed weeks). An abnormal outcome was defined as a “refer” result in either ear on either test. Groups were compared using the chi-square test and odds ratio (OR). Of 349 participants, 240 (68.8%) were born preterm and 109 (31.2%) were born at term. Overall, 169 participants (48.4%) had an abnormal hearing-screening result. The proportion was 45.8% (110/240) among premature participants and 54.1% (59/109) among term participants, with no significant difference (χ²=1.746; p=0.186; OR=0.72, 95% CI 0.45–1.13). High proportions of abnormal screening outcomes were observed among participants with documented ototoxic drug exposure (13/13, 100%), asphyxia (27/36, 75.0%), and hyperbilirubinemia (13/19, 68.4%). Prematurity alone was not associated with abnormal early hearing-screening outcomes in this high-risk population. The high referral rate supports universal screening and targeted audiological follow-up, particularly for participants with ototoxic exposure, asphyxia, or hyperbilirubinemia.