Table Risk factors for hearing loss in neonates include the following: Low birth weight (eg, < 1.5 kg) Apgar score < 5 at 1 minute or < 7 at 5 minutes Hypoxemia or seizures resulting from a difficult delivery Prenatal infection with rubella, syphilis, herpes, cytomegalovirus, or toxoplasmosis Craniofacial anomalies, particularly those that involve the external ear Hyperbilirubinemia Sepsis or meningitis Ventilator dependence Use of ototoxic drugs Family history of early hearing loss Infants and children The most common causes of hearing loss in infants and children are Cerumen accumulation Middle ear effusions, including otitis media with effusion Other causes in older children include head injuries, loud noises (including loud music), use of ototoxic drugs (eg, aminoglycosides, thiazides), viral infections (eg, mumps), tumors or injuries affecting the auditory nerve, foreign bodies of the ear canal, and, rarely, autoimmune disorders.