OBJECTIVE: To verify if neonatal hypoxia is a predictor of referral for a universal newborn hearing screening. METHODOLOGY: Neonates born at a tertiary care hospital from January 2007 to December 2011 were enrolled in the study. The variables were classified as: (a) exposure (a low Apgar score); (b) stratification variables (gestational age and presence of a risk indicator for hearing loss); and (c) outcome (referral for transient otoacoustic emission of either ear). The relation between a low Apgar score and referral for a newborn hearing screening was analyzed by simple logistic regression. RESULTS: A total of 6301 neonates were screened; 15.82% had a risk indicator for hearing loss and a low Apgar score affected 6.57% (n = 414). Among them, 6.59% (n = 415) were referred for abnormal transient otoacoustic emission, and statistical analysis showed that neonates with low Apgar scores had a 58% greater chance of referral for screening (OR = 1.58; 95% CI = 1.07-2.33). CONCLUSION: The presence of a risk indicator for hearing loss increases the chances of referral for otoacoustic emission, and the presence of neonatal hypoxia is a predictor of referral for a universal newborn hearing screening.