The American Academy of Pediatrics has recommended that all infants have their hearing screened as early as possible to allow for early identification(3 months) and intervention (6 months). Since mid-1995, we and six other sites in New York State began a universal newborn hearing screening program. The hearing of all infants born or transferred to Stony Brook was screened using otoacoustic emissions (OAE) and/or automated ABR prior to hospital discharge. Those infants that failed were rescreened using the same methods within a month. New York State awarded each site $22.50 per infant screened. Infants that failed the second screening were referred to audiology/ENT for diagnostic evaluation. We sought to determine the cost of indentifying congenital hearing loss in low risk, normal newborn (NB) infants verses high risk, neonatal intensive care (NICU) infants. In 1995, we screened a total of 2,056 infants (98.9%, 23 missed). 15 of 420 NICU infants (3.6%) and 67 of 1,636 NB babies (4.1%) were referred for rescreen. 70% returned for rescreen. 84% of those rescreened passed, 16% (n= 9 ) failed and were referred for Audiology evaluation. Six of these 9 (67%) had hearing loss. In 1996, 3,330 infants were screened through November (99.6%, 11 missed). 33 of the 630 from NICU (5.2%) and 40 of the 2,700 from NB (1.5%) were referred for rescreen. 82% returned for rescreen, 10% are pending, 8% were lost (n=6). 55% of referrals passed rescreening; 27% failed(n= 20) and referred to Audiology. Eight of these 20 were from NB and 7 have hearing loss, 1 is pending testing. Of the other 12 NICU referrals, 1 was normal, 2 are pending, and the other 9 have hearing loss. The positive predictive value of hearing loss after having failed one vs two scrrening increased from 14% to 76%. At $22.50 per infant, the cost to identify a baby at Stony Brook with hearing loss is $6,060. For NB this is$8,869 vs $2,625 for a NICU infant, a difference of more 3 fold. If one assumes the cost of education is >$15,000 different per year for a hearing impaired and habilitated child vs a deaf child, then universal screening represents a cost savings. We conclude that universal newborn hearing screening can be done efficiently at at relatively low cost. Sponsored by the NYS Department of Health.