Over the last two decades there has been a great deal of discussion concerning hearing loss in infants and the most appropriate diagnostic strategies to identify these children so that early intervention can be provided. This article reviews the developments that have transpired to allow universal newborn hearing screening programs to become the standard of care throughout most of North America. The article also examines ongoing controversies in universal newborn hearing screening and future needs to enhance universal newborn hearing screening, with the ultimate goal being early intervention for children identified with hearing loss through these programs.