BACKGROUND/OBJECTIVES: Although newborn hearing screening (NHS) programs have been successfully implemented in many countries worldwide, challenges to these programs have been reported in the literature, such as a lack of awareness among families and healthcare professionals and limited funding. Challenges to the NHS programs in Saudi Arabia have not been systematically reported. This study aimed to assess the level and quality of evidence supporting the existing challenges of the NHS programs in Saudi Arabia. METHODS: A systematic review of all peer-reviewed literature on Saudi NHS programs published between 2016 and 2024 was conducted according to the PRISMA guidelines. Search strategies were executed in seven databases. Data were collected from studies that met the inclusion criteria. RESULTS: A total of 37 records were reviewed, and 13 peer-reviewed publications met the inclusion criteria. Characteristics of included studies were classified by study language, study sample, sample size, location of the study sample, study purpose, and study method via evidence tables. Each study was critically appraised according to the quality. Results revealed that cross-sectional prospective description was the main research design with low strength of evidence. Six main challenges were identified and described: lack of awareness and gaps in knowledge, lost to follow-up, inadequate data entry, management, and tracking system, limited or absence of services in some residential areas, insufficient training and frequent changes of NHS personnel, and absence of a standardized NHS protocol. CONCLUSIONS: This review may assist in overcoming these challenges and improving the NHS programs in Saudi Arabia. There is a need to establish national education campaigns about the NHS programs, improve documentation by using database management and tracking systems, and expand the early hearing detection and intervention (EHDI) services for children in all Saudi regions.