The imperative of newborn screening programs in developing countries: beyond the illusion of health at birth

Newborn screening (NBS) represents one of the most significant achievements in preventive public health, enabling early detection of congenital disorders before symptom onset. While developed nations have established comprehensive NBS programs covering 30–50 conditions, many low- and middle-income countries (LMICs) lack systematic screening, creating profound health inequities. This review examines the critical need for NBS implementation in LMICs, deconstructing the assumption that a “healthy appearance (asymptomatic)” at birth guarantees long-term health. Through analysis of epidemiological data, economic considerations, and ethical frameworks, evidence indicates that NBS is a cost-effective intervention that addresses a substantial burden of preventable mortality and disability in LMICs. We then present implementation strategies tailored to LMICs, including phased rollout starting with non‑time‑critical disorders, use of cord blood or point‑of‑care tests, integration with existing maternal and child health contacts, and innovative digital solutions for result tracking. Finally, we offer policy recommendations to bridge the global NBS disparity gap, emphasizing sustainable financing, health system strengthening, and equitable access to confirmatory diagnosis and treatment.