Objectives: Newborn hearing screening has been successfully implemented in cities of China, but not in rural areas. This study aimed to provide guidance on implementing hearing screening in the rural areas of China. Methods: Subjects were 11,568 babies who were born in 5 counties of Hubei Province of China. Hearing screening followed a two-stage strategy with transient evoked otoacoustic emissions (TEOAEs). Infants referred after the second-stage screening were tested by diagnostic auditory brainstem response (ABR). Results: The subjects screened included 10,665 (92.2%) normal newborns and 903 (7.8%) newborns with high-risk of hearing loss. While 8190(70.8%) newborns passed the initial screening, 135 newborns failed in the re-screening, and 90(66.7%) of these 135 newborns received diagnostic assessment. Finally, 58 infants were diagnosed as hearing loss, and the prevalence of congenital hearing loss among newborns in rural areas was 0.5% (58/11,568). Conclusions: This large-scale newborn hearing screening in rural areas of Hubei Province of China demonstrated that the screening rate and referral rate for high-risk infants are low. Urgent measures should be taken by the government to promote newborn hearing screening in the rural areas. (C) 2012 Elsevier Ireland Ltd. All rights reserved.