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Background Hearing impairment is one of the most common birth defects in children.Universal newb hearing screenings have been performed for 19 years in Guangdong province,China.A screening/diagnosis/intervention system has gradually been put in place.Over the past 10 years,a relatively complete data management system had been established.In the present study,an etiological analysis of newb cases that failed the initial and follow-up screenings was performed.Methods The nature and degree of hearing impairment in newbs were confirmed by a set of procedures performed at the time of initial hearing screening,rescreening and final hearing diagnosis.Then,multiple examinations were performed to explore the associated etiology.Results Over a period of 10 years,720 children were diagnosed with newb hearing loss.Among these children,445 (61.81％) children had a clearly identified cause,which included genetic factor(s) (30.56％),secretory otitis media (13.30％),matal rubella virus infection during pregnancy (5.83％),inner ear malformations (4.86％),matal human cytomegalovirus infection during pregnancy (2.92％),malformation of the middle ear ossicular chain (2.50％) and auditory neuropathy (1.81％).In addition,275 cases of sensorineural hearing loss of unknown etiology accounted for 38.19％ of the children surveyed.Conclusions Long-term follow-up is needed to detect delayed hearing impairment and auditory development in children.The need for long-term follow-up should be taken into account when designing an intervention strategy.Furthermore,the use of the deafness gene chip should further elucidate the etiology of neonatal hearing impairment.