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Although previous studies have documented the feasibility and benefits of universal newborn hearing screening, none have reviewed the effectiveness of regionally mandated participation of large numbers of hospitals with variable levels of motivation to succeed. The purpose of this study was to measure hospital participation and overall screening success in a statewide program for universal newborn hearing screening and to track improvements in program establishment and outpatient followup over time. Sree Balaji medical college & hospitals voluntarily performed hearing screening before hospital discharge on all newborns from 2012 to 2014. The publication of screening results from these early years served as a catalyst for legislation requiring increased hospital participation in establishing universal screening programs. Data systems were subsequently developed to improve statistical tracking and follow-up.The cumulative study data as well as the results from calendar year 2012 to 2014 were reviewed for collective measures of successful screening and follow-up used otoacoustic emission testing.Hearing loss was defined as a threshold of 35 decibels or greater in 1 or both ears at the time of confirmatory testing. During the full 3-year study period, 2012 to 2014, 1000 newborns were screened. A total of 150 infants who were born during the study period received a diagnosis of congenital hearing loss. In this cohort of 150 children, the cumulative frequency of bilateral hearing loss was 71% (range: 48%–94% by calendar year), the frequency of sensorineural hearing loss was 82% (range: 67%–88%), and the frequency of 1 or more risk factors was 47% (range: 37%–61%). The median age of diagnosis of congenital hearing loss was 2.1 months; 71% of affected infants were identified by 3 months of age (the recommended standard for age of diagnosis), and 92% of affected newborns were identified by 5 months of age. Measures of screening success were compared for large, mid-sized, and small hospitals. Increasing hospital size, as measured by the number of births per year, was associated with an increasing percentage of newborns who were successfully screened. It was notable that smaller hospital size was associated with increased referral rates for follow-up testing, whereas larger hospital size was associated with the highest recapture rate for follow-up testing. Universal screening for congenital hearing loss is demonstrated to be feasible in a large regional effort of legislatively mandated participation. The success of such an endeavor is dependent on educational efforts for community professionals, commitment on the part of program planners, and data systems that more accurately track and recall infants who fail initial hospitalbased screening.

Newborn Hearing Screening Project, 2012-2014 on the Threshold of Effective Population-Based Universal Newborn Hearing Screening