UNHS is the first step in the EHDI program which indicates whether a newborn requires further audiological assessment to determine the presence or absence of permanent hearing loss.

[5][6][7][8] In order to be most effective in minimizing developmental delays and promoting communication, education and social development, timely and appropriate interventions need to follow the early identification of hearing loss.

For interventions to be effective, they should be appropriate, timely, family-centered and undertaken through a coordinated interdisciplinary approach, which includes access to specialists who have the professional qualifications and specialized knowledge and skills to support and promote optimal development outcomes.

[16] In order to maximize language and communication competence, literacy development, and psychosocial well-being, the U.S. Joint Committee on Infant Hearing[17] endorses the goals that 1) all newborns should undergo hearing screening using physiologic measures prior to hospital discharge, but no later than one month of age 2) all infants whose do not pass screening should have appropriate audiologic diagnosis no later than three months of age and 3) all infants identified as deaf or hard of hearing in one or both ears should be referred to early targeted and appropriate intervention services as soon as possible after diagnosis, but no later than six months of age.

Newborn hearing screening employs objective assessment methods, either with automated (ABR) or (OAE), or both for initial and/or rescreening procedures.

[18] Hearing loss in neonates is the most common congenital birth defect and sensory disorder, and can be caused by a variety of reasons.

Congenital hearing loss can be due to genetic causes, environmental exposures during pregnancy, or health complications shortly after birth.

[21] Population-based studies in Europe and North America have identified a consistent prevalence of approximately 0.1% of children having a hearing loss of more than 40 decibels through review of health or education records, or both.

[38] In addition to meeting the "1-3-6" targets, one of the key challenges for newborn hearing screening programmes is to reduce 'loss to follow-up' (where a child does not return for the next stage of the process).

[41] Newborn screening alone can miss postnatal, progressive or acquired hearing loss, there is poor identification of perinatal infections, and concerns over regulatory barriers and privacy continue to this day.

[42] Many infants are lost to follow-up and many families face the challenge of navigating coordinated quality care through complex health to education systems involving multiple agencies.

[43][44][45] In 1956, Erik Wedenberg published one of the earliest articles describing examiner use of tuning forks, percussion sounds, pitch pipes, and cowbells to screen the hearing newborn infants.

"[46] In 1963, Marion Downs, affectionately referred to as the "mother of pediatric audiology", pioneered the first hospital based infant hearing screening programme in Denver, Colorado, using Behavioral Observation Audiometry (BOA).

[49] In 1989 Surgeon General C. Everett Koop, perhaps most remembered for his work related to abortion, tobacco, and AIDS, called for increased efforts to identify congenital hearing loss within the first year of life.

"[50] In 1990, the JCIH added three more risk factors (ototoxic medication, prolonged mechanical ventilation, syndromic stigmata) for a total of ten.

In 1996, the US Preventive Services Task Force concluded that the evidence was insufficient to assess the balance of benefits and harms and assigned an "I Statement" grade for newborn hearing screening.

In addition, the National Institute on Deafness and Other Communication Disorders at NIH provided the authority to continue a programme of research and development on the efficacy of new screening techniques and technology.

[33] With growing research evidence, in 2007 United States Preventive Services Task Force (USPSTF) recommended screening of hearing loss in all newborn infants with an assigned B grade.

By 2010, 43 states enacted legislative statutes or written regulatory language related to universal newborn hearing screening.

[58] These profiles promote the automated collection and communication exchange of EHDI data between clinical and public health information systems (results, demographics, care plans, quality measures).