The screening procedure and the birth group were 2 protocol and program features that this systematic review identified research that examined how they affected these 2 outcomes. About 5 datasets were looked at, including studies that described the predicted outcomes in connection to a protocol or program level element and provided original information from newborn hearing screening. Studies with methodological bias, those that only included information on 1 ear, 1 risk factor, or fewer than 100 babies, were not accepted. The 3 areas of sample, screening, and result were utilized to evaluate the quality of the included studies using modified criteria from the Ottawa-Newcastle and QUADAS-2 scales. The outcomes from the included studies were summarised in tables, figures, and text. About 8 studies looked at a low loss to follow-up (LTFU) rates, 58 studies looked at referral rates, and 35 research looked at combination rates. Only 15 researchers defined LTFU. The rates of referral and LTFU substantially varied between trials. In 12 of the 14 studies that looked at screening methods, low referral rates using an aABR were observed in comparison to TEOAE well babies (WB). Rescreening before hospital discharge and screening that starts 3 days after delivery both helped to lower the referral rate. Studies on LTFU have shown that rates are lower in programs that use audiologists, don’t charge for step 2, and schedule follow-up appointments in locations that are convenient for the family. Programs with lower overall LTFU had higher LTFU for neonates from the NICU as compared to WB. Despite the fact that incomplete reporting and the omission of non-English studies may have made it harder to generalize the results of this analysis, it was nevertheless possible to identify important influencing factors for referral and LTFU rates. In spite of the fact that aABR can significantly lower referral rates during WB screening, this was not the sole fix. The disparity in reported referral and LTFU rates among studies emphasizes the significance of various factors the study looked at as well as the context in which the program is being run. Babies who are more likely to experience hearing loss should receive special attention so that they can be closely watched.