Universal newborn hearing screening as an effective measure to prevent and control hearing impairment has been promoted nationwide, and Shanghai in particular, as one of the researchers and promoters of this project, has been at the forefront of universal newborn hearing screening. However, for delayed hearing loss that does not exist at birth, newborn hearing screening cannot detect it in time, but over time, this group of children will gradually develop hearing loss. In other words, delayed hearing loss cannot be ignored in preschool and school-age children. Delayed hearing impairment is defined as hearing loss that occurs gradually during postnatal growth and development, and is currently of concern for preschool and school-age children aged 3-15 years, with the incidence of permanent delayed hearing impairment ranging from 11% to 50%. Hearing loss in preschoolers between the ages of 3 and 6 years old is a critical period for learning and acquiring language skills, and hearing loss during this period can severely impact a child’s ability to communicate and learn later in life, as well as increase the cost of education to society. Unilateral hearing loss has also been found to adversely affect speech development, learning ability, and long-term development, and even mild hearing loss can significantly affect children’s behavior and performance in school. In preschool children, the prevalence of hearing loss ranges from 14.9% to 19.5%, and more than half of these children have conductive hearing loss. Some of the children with conductive hearing loss can regain their hearing within 2-3 months, but some of them have permanent hearing impairment, because these hearing losses are mainly characterized by delayed or gradual or fluctuating, with atypical performance, which is difficult to be detected by parents or teachers in daily life. For example, some children may have difficulty concentrating, answering questions, getting tired easily, or having poor academic performance, which may be caused by hearing loss, while parents and teachers do not easily associate these phenomena with hearing problems. According to the Second National Sample Survey of People with Disabilities released in December 2006, more than 80,000 cases of children are diagnosed with delayed onset hearing impairment in China each year. Universal hearing screening of newborns does not detect children with delayed hearing impairment, and existing hearing screening techniques require specialized hearing testing equipment and environment, which must be done in a medical soundproof room, all of which limit the diagnosis rate of children with delayed hearing impairment. The Internet-based child play audiometry technology developed by the Institute of Otology of Shanghai Jiaotong University Medical School is based on Internet technology, with the audiometry software installed on mobile electronic devices, and children can wear noise-canceling headphones to complete the hearing screening during the game. The screening results are directly uploaded to the Internet cloud for processing, and the screening results are fed back on site so that kindergarten teachers or parents can guide the children to complete the hearing screening. From May 2012 to November 2015, the Ear Institute completed a total of 11,374 preschool children in kindergartens in Yangpu District, screening 962 children who failed to pass the referral, confirming 177 children with conductive hearing impairment and 20 children diagnosed with permanent hearing impairment. The clinical manifestations of delayed hearing impairment in children are not typical, but it has a great impact on their speech development, social and academic performance and social behavior, therefore, early detection and early intervention of delayed hearing impairment in children should be achieved. It is expected that through joint attention, the prevention and control of delayed hearing impairment will be raised to the level of prevention and control strategy of congenital deafness, and we will work together to return a beautiful hearing world to children. Newborn Hearing Screening Procedures Effective hearing screening, initial screening is best done before the newborn is discharged from the hospital. If screening tests are performed after the newborn is discharged from the hospital, it is often difficult to find a quiet testing environment and a quiet testing state for the infant. Newborns who do not pass the initial screening are re-screened for hearing at 42 days (rescreening). Rescreening is important for hearing screening because it reduces the false positive rate and facilitates timely audiological diagnosis and intervention for newborns who may have deafness. If screening is targeted to newborns or infants with risk factors for deafness, only 50% of newborns or infants with deafness will be screened. Therefore, screening should be offered to all newborns or infants. A complete newborn hearing screening system should include the following components: screening techniques, early deafness diagnosis techniques, early intervention techniques for deaf children and appropriate and timely hearing rehabilitation measures, database network establishment and management, and quality control evaluation system. Hearing screening is different from diagnosis. Otherwise screeners would regard screening results as a criterion for diagnosing deafness. Screening is an initial identification of those who may be deaf using relatively simple, quick, inexpensive, and reliable techniques. Those newborns who do not pass screening are diagnosed with a more comprehensive, definitive approach to deafness; if deafness is indeed present, the type and extent of deafness is described in detail to allow for early intervention. Targeting the resources for confirmatory diagnosis to a relatively small population saves society money and reduces unnecessary parental anxiety. Hearing screening is a quick and simple technique to identify the presence or absence of hearing in a large population that may be deaf. Newborn Hearing Screening Technology Hearing screening is a quick and simple technique to identify the presence or absence of hearing in a large population of potentially deaf people. Large-scale screening requires simple, rapid, and inexpensive screening techniques. The main methods used today to screen newborns for hearing function are automated auditory brainstem evoked potential (AABR) and otoacoustic emission (OAE). Both methods have advantages and disadvantages, and the failure rate of OAE is higher than that of AABR, so the two methods can be combined. For example, using OAE during primary screening and AABR during re-screening is the more recommended method. For NICU, the AABR method can be used. Automatic Auditory Brainstem Evoked Potential (AABR), is an ABR test method that can automatically discriminate results. A short sound with a sound intensity level of 35 dB nHL is administered through an over-the-ear headset or disposable ear coupler, and the waveform is obtained through a sensor placed on the infant’s forehead. The system compares the obtained waveform with a template to obtain a pass or fail result, and infants who do not pass will require further hearing evaluation. The template is taken from the ABR synthetic waveforms of 35 hearing normal newborns. The otoacoustic emission (OAE) method is an audio energy produced by the outer hair cells of the cochlea and released into the external auditory canal via the auditory chain and tympanic membrane conduction. Studies have shown that the presence of otoacoustic emissions is closely related to normal hearing function. Deafness above 40 dBHL leads to a reduction or loss of otoacoustic emissions. The techniques used for newborn hearing screening are transient evoked otoacoustic emissions (TEOAE) or distortion product otoacoustic emissions (DPOAE), the latter being frequency specific.