A common practice in Universal Newborn Hearing Screen (UNHS) programs is rolling up non-simultaneous passing results in each ear (SW_EAR) from repeat automated screens into a bilateral pass. This study aims to provide evidence-based criteria for best practices regarding SW_EAR screens. From January 2010 to May 2013, infants with SW_EARs results were prospectively monitored by MEDNAX-Pediatrix’s nationwide UNHS program, which combine inpatient/outpatient screens utilizing automated auditory brainstem response (AABR). The tracked audiologic evaluations of 16,129 refer infants (2,334 due to SW_EAR) out of the total infant population screened (2,492,314) were analyzed retrospectively. A high proportion of hearing loss (354/2334, 15%) was identified in infants with SW_EAR screens. Of those identified, 159 infants had a permanent hearing loss (PHL), 98 infants were fit with hearing aids and 7 received cochlear implants. When including SW_EARs as a criterion for referral, the screening protocol identified one more infant with PHL in every one hundred screened positive, maintaining referral and false positive rates of < 0.7 % and