End of an Era, or Just Another Inflection Point in the History of Newborn Screening in the United States?

We have reached another inflection point-perhaps the end of an era-in state newborn screening programs. Frequently touted as one of the great achievements in public health, newborn screening in the United States is remarkable in part because of the role of state government in routine pediatric care and because of the role of the federal government in the standardization of health policy through an evidence-based, publicly engaged process. These and other long-standing characteristics of newborn screening are being challenged by the extraordinary realignments in federal government and by the long-awaited advances in screening technologies, gene therapy, and other novel therapies. This is not the first time state newborn screening programs seemed precarious; in fact, there have been challenges to state newborn screening nearly every decade since it began in the 1960s. However, recent disruptions to key components of newborn screening in the United States have the potential to radically reshape the future of public health approaches to newborns with rare diseases.