After a brief review of the history of newborn hearing screening including the Downs behavioral testing procedure, the Crib-o-gram and similar devices, and the use of auropalpebral reflex and otoacoustic emissions, there is a discussion of key issues that need to be resolved before universal hearing screening is introduced. Included are questions regarding the target population(s) of screening programs, well baby versus NICU screening, dealing with false-positives and the effects on parent-child relationships, and finally, the availability of resources for screening and follow-up. The results of a recent study in the United Kingdom that assessed the current state of audiology services and found there is a difference between existing standards and what is actually being done in practice, are presented and considered in terms of current trends in the United States to move ahead with universal screening without a solid database of information regarding the preparedness of clinical centers to deal with the need for services that will result from the initiation of universal programs. Caution is urged.

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Auditory brain stem responses [ABRs] to a i r and boneconducted clicks were used to assess the auditory status of 170 atirisk neonates. During the perinatal period, 20.6% [35/170 cases] of the at-risk infants failed ABRs to airconducted clicks at 30 dB nHL in a t least one ear. Earspecific results indicated an initial failure rate of 15.0% [51/340 ears]. Approximately twctthirds (32/51 ears] of these initial failures showed purely conductive deficits, whereas the remaining one-third [ I 9/51 ears] involved suspected sensorineural components. Follow-up audiological evaluations were performed for 87.1% ( 1 4 8 cases] of these atirisk infants at 4 mo and/or 1 yr corrected age. Based on the initial tests and followup assessments, the tentative operating characteristics of ABRs to both a i r and boneconducted clicks for identification of sensor ineural deficits in at-risk neonates were calculated. It was found that the ABR to boneconducted clicks yielded better specificity, predictive value of positive results, and overall efficiency. It is suggested that the ABR to boneconducted stimuli should be viewed as a valuable addition in the assessment of cochlear reserve in infants who fail a newborn auditory screening to airconducted stimuli.