Recently, a National Institutes of Health Consensus Statement recommended that all infants be screened for hearing prior leaving the birthing hospital using a two-stage screening process based on transient evoked otoacoustic emissions (TEOAEs). Although the value of identifying hearing loss before 1 year of age is widely recognized, the feasibility of universal newborn hearing screening using TEOAE is sometimes questioned because it is presumed that the technique has a high false positive rate and is not cost efficient. This paper presents new data for 4253 infants from an operational universal newborn hearing screening program using a TEOAE procedure that answers those arguments.