International Journal of Pediatric Otorhinolaryngology (2004) 68, 165—174 Voluntary progress toward universal newborn hearing screening  Joseph E. Kerschner a, * , John R. Meurer b , Ann E. Conway c , Sharon Fleischfresser d , Melissa H. Cowell d , Elizabeth Seeliger d , Varghese George e a Division of Pediatric Otolaryngology, Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, WI, USA b Department of Pediatrics, Center for the Advancement of Urban Children, Medical College of Wisconsin, Milwaukee, WI, USA c Wisconsin Association for Perinatal Care, Madison, WI, USA d Program for Children with Special Health Care Needs, Division of Public Health, Wisconsin Department of Health and Family Services, Madison, WI, USA e Department of Biostatistics, School of Public Health, University of Alabama–Birmingham, AL, USA Received 31 July 2003; accepted 8 October 2003 KEYWORDS Universal newborn hearing screening; Auditory brainstem response testing; Rural hospitals; Home births Summary Objectives: Thisstudyassessedtheprevalenceofnewbornhearingscreen- ing in Wisconsin between 1997 and 2001, and examined factors leading to establish- ment of programs and influencing the outcomes of universal newborn hearing screen- ing (UNHS). The primary goal was to identify characteristics that might be important for states, provinces or countries that have not yet implemented UNHS programs and to examine some unique components of the Wisconsin UNHS program, that may provide direction to areas both with and without programs. Methods: The study con- sisted of two cross-sectional surveys administered at two separate time points (2000 and 2001). Additional data was provided by the Wisconsin Sound Beginnings Early Detection and Hearing Intervention database. Results: Between 1997 and 2001, the number of Wisconsin birthing hospitals with UNHS programs increased from two to 92 of a total of 103 and the percent of all Wisconsin newborns screened for hearing loss before 1-month of age increased from 10 to 90%. In 2001, 2.6% of screened newborns had an abnormal test requiring further audiologic evaluation, with a higher rate of referral in programs relying only on otoacoustic emission testing versus automatic au- ditory brainstem testing. As programs were being established, hospitals with greater number of deliveries more readily developed UNHS programs and hospitals with more deliveries were also significantly more likely to screen a greater percentage of deliv- ered children once their programs were established. The Wisconsin Sound Beginnings  Data from portions of this manuscript was presented at the Wisconsin Association for Perinatal Care Annual Meeting in Appleton, Wisconsin, on 10 April 2000. Additional data in this manuscript has been submitted for presentation at the SENTAC Annual Meeting in New Orleans, Louisiana in October 2003. * Corresponding author. Present address: Department of Otolaryngology and Communication Sciences, Children’s Hospital of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA. Tel.: +1-414-266-6486; fax: +1-414-266-6989. E-mail address: kersch@mcw.edu (J.E. Kerschner). 0165-5876/$ — see front matter © 2003 Published by Elsevier Ireland Ltd. doi:10.1016/j.ijporl.2003.10.010