Objective To determine the incidence of auditory neuropathy spectrum disorder (ANSD) and its risk factors among the neonatal intensive care unit (NICU) population from 2009 to 2018 in the Pediatric Health Information System database. Study Design Retrospective national database review. Setting Population-based study. Methods The Pediatric Health Information System database was queried to identify patients ≤18 years old with NICU admission and ANSD diagnosis. Patient demographics, jaundice diagnosis, use of mechanical ventilation, extracorporeal membrane oxygenation, furosemide, and/or aminoglycosides were extracted. Multivariable linear regression was used to assess trends in incidence. Chi-square analysis was used to assess differences between patients with and without ANSD. Logistic regression was used to assess factors associated with ANSD. Results From 2009 to 2018, there was an increase in (1) NICU admissions from 14,079 to 24,851 ( P < .001), (2) total ANSD diagnoses from 92 to 1847 ( P = .001), and (3) annual total number of patients with ANSD and NICU admission increased from 4 to 16 ( P = .005). There was strong correlation between the increases in total number of NICU admissions and total ANSD diagnoses over time ( R = 0.76). The average ANSD incidence was 0.052% with no statistically significant change over 10 years. When compared with all NICU admissions, children with ANSD had a higher association with use of furosemide ( P < .001) and ventilator ( P < .001). Conclusion Despite a statistically significant increase in NICU admissions and total ANSD diagnosis, the incidence of ANSD in the NICU population has not increased from 2009 to 2018. Furosemide and mechanical ventilator use were associated with increased likelihood of ANSD.