Hearing impairment is a common cause of disability worldwide with Sub-Saharan Africa accounting for a greater burden of this impairment. It’s adverse impact on the affected individual ranges from impeded speech development and poor learning to stigmatization. Several reports have studied the prevalence of hearing impairment but there are very limited studies depicting the association between hearing impairment and neurodevelopmental outcomes globally. This study aimed to determine the prevalence of hearing impairment in the newborn period (among high risk and healthy controls) and its association with neurodevelopmental outcomes at 6-8 months at the Lagos University Teaching Hospital. This prospective cohort study was carried out among 300 neonates (150 high risk and healthy controls respectively) over eleven months (January to November 2018). During the neonatal period, the study participants were screened for hearing impairment using otoacoustic emissions (OAE) while automated auditory brainstem response (AABR) was used to confirm hearing impairment. A follow-up evaluation was conducted using the same tools at 6-8 weeks while middle ear abnormality was also determined at this period using tympanometry. The severity and types of hearing impairment were also evaluated. Neurodevelopmental assessment was conducted at 6-8 months of age using the Malawi Development Assessment Tool (MDAT). The medians and frequencies were compared using Chi square and Fishers exact test. Binary logistic regression was done for significant variables, with p-values < 0.05 taken as significant. The Median age of the study participants in both groups was 5 days (IQR 3-8). Hearing impairment was noted in 12(11.3%) of the high-risk neonates which was significantly higher than that of the control group 1(0.97%), p = 0.004. All the healthy controls had normal neurodevelopment; 16(18.6%) of the high-risk neonates had developmental delay principally in gross motor skills. There was significant association between neurodevelopmental delay and hearing impairment (p<0.0001). Using binary logistic regression, severe neonatal jaundice with bilirubin encephalopathy (OR{95%CI} 24.5{2.7, 221.7} p=0.004) and maternal chronic hypertension (OR {95%CI} 0.12{0.12, 0.95} p= 0.045) emerged as significant risk factors for hearing impairment in the subjects. Severe perinatal asphyxia (OR {95%CI} 4.4{1.2, 16.3} p =0.024) and lack of antenatal care (OR {95%CI} 0.19{0.03, 0.94} p = 0.042) were significantly associated with neurodevelopmental delay. This study has shown that the prevalence of hearing impairment was significantly higher in high risk neonates compared to healthy controls and adverse neurodevelopmental outcomes were significantly associated with hearing impairment. Chronic maternal hypertension and severe jaundice with bilirubin encephalopathy were significant risk factors for hearing impairment. Severe perinatal asphyxia and lack of antenatal care were significantly associated with developmental delay. Thus, routine neonatal management should include hearing evaluation and neurodevelopmental evaluation in high risk neonates for timely and appropriate interventions in health facilities.