Background Newborn hearing screening has been nationally implemented, but longitudinal cohort follow-up is required to inform Children's Hearing Services of the requirements for postneonatal care pathways.

Methods A 10-year cohort of 35 668 births enrolled into a Universal Neonatal Hearing Screen was followed up until the children had completed the first year of primary school.

Results There were 3.65/1000 children with a permanent hearing impairment of any degree embarking on their education. 1.51/1000 had a moderate or worse bilateral deafness but only 0.9/1000 with this degree of deafness had been identified by newborn screening. Postneonatal care pathways were required to identify those with congenital impairments missed by the screen (0.11/1000), those moving into the district (0.25/1000) and those with late onset deafness (0.25/1000). An additional postneonatal yield of 1.2/1000 had mild or unilateral impairments. When all degrees of impairment were considered 51% of the children with a permanent hearing impairment had required identification by postneonatal care pathways.

Conclusions Despite the success of the newborn hearing screen, the provision of postneonatal pathways remains essential for identifying deafness in early childhood.