Expanding newborn screening through genomics

Background: Newborn screening (NBS) is one of the most significant public health achievements, traditionally using biochemical and physiologic tests to detect rare but treatable conditions. The emergence of genomic sequencing technologies, including whole-genome sequencing (WGS), now offers the ability to identify thousands of variants underlying pediatric disorders. These advances create new opportunities to transform NBS but also raise important clinical, ethical, and policy challenges. Purpose: This article explores the implications of genomic NBS for advanced practice nursing, with a focus on lessons from the NIH-funded BabySeq Project and the policy precedent set by Florida's 2025 Sunshine Genetics Act, the first statewide, publicly funded WGS-NBS program in the United States. Discussion: BabySeq demonstrated that genomic sequencing can identify actionable variants in approximately 9% of infants, yet it also exposed ethical tensions regarding disclosure of adult-onset findings and the contested concept of “family benefit.” Florida's Sunshine Genetics Act expands NBS beyond the federal Recommended Uniform Screening Panel, aiming to reduce diagnostic odysseys and promote equity of access. However, unresolved issues persist, including informed consent, return of uncertain or adult-onset findings, and data stewardship. For nurse practitioners, the integration of genomic sequencing into NBS underscores new roles in parental education, consent counseling, care coordination, and long-term follow-up. Ensuring equity, cultural sensitivity, and alignment with professional guidelines will be essential to implementation. Conclusions: WGS in NBS has the potential to improve outcomes for children and families by enabling earlier diagnosis and intervention. Nurse practitioners, as frontline providers in primary care and pediatrics, are uniquely positioned to support families through genomic education, ethical decision making, and care navigation. Building workforce genomic competency and advocating for equitable policies are critical to realizing the promise of genomic NBS in clinical practice.