BACKGROUND: The incidence of congenital hearing impairment is 1-2/1,000--higher than for congenital hypothyroidism and phenylketonuria combined. Universal screening of hearing impairment has been introduced in many countries with portable otoacoustic emission (OAE) and/or automated auditory brainstem response (AABR), but not in Norway. This is the first Norwegian report on universal hearing screening of newborns before hospital discharge. MATERIALS AND METHODS: All newborns in Østfold County (n = 5,712) in 2000 and 2001 were offered an OAE test on the second day in nursery by a two-step model. After two tests without OAE signals bilaterally, the infants were referred to the audiology clinic. RESULTS: 98.8% of the newborns were tested. Of these, 97.0% had a pass response after two tests. 169 (3.0%) were referred to the audiology clinic; 15 were withdrawn from follow-up examination by their parents. 23 infants had auditory brainstem response audiometry done, and sensorineural hearing impairment was found in six (1.0/1,000). Three infants (0.6/1,000) had conductive hearing impairment. INTERPRETATION: Our screening model was appropriate and cost-effective. The incidence of congenital hearing impairment was similar to that reported by others. The number of parental refusals should be reduced. This may be achieved by adding an AABR to the two OAE tests.