Abstract
Universal newborn hearing screening (UNHS) is widely implemented, but long-term population-based evaluations of programme performance remain limited. This study aimed to evaluate long-term performance of a regional UNHS programme over an 11-year period, focusing on screening coverage, referral rates, and diagnostic outcomes across screening modalities. This retrospective population-based cohort study included all live-born infants in the Central Denmark Region from 2015 to 2025. Screening pathways were categorised in three groups: automated auditory brainstem response (AABR)-only screening for infants without recognised risk factors, combined AABR and otoacoustic emissions (OAE) screening for infants with recognised risk factors, and a group in which only OAE screening was recorded. Programme outcomes included screening coverage, primary referral rate, final referral rate to diagnostic auditory brainstem response (D-ABR), and diagnostic yield. Among 160,719 live-born infants, 157,849 (98.2%) underwent screening. Overall, 5,070 infants (3.2%) were referred after primary screening. Primary referral rates were 0.2% for AABR-only screening and approximately 15% for OAE-based screening pathways (p < 0.001). Of referred infants, 85.5% achieved bilateral pass at audiological rescreening, and only 732 infants (0.46% of screened infants) proceeded to D-ABR. Among these, 417 had confirmed hearing loss (diagnostic yield 57.1%). The programme demonstrated stable long-term performance with high screening coverage and low final referral rates within a structured, risk-adapted screening model. AABR-based screening in non-risk infants was associated with a very low primary referral rate while maintaining diagnostic yield. These findings support the use of AABR as a primary screening modality within structured UNHS programmes.