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Newborn screening is an initiative designed to identify infants with serious health conditions who could benefit from early detection and treatment. Begun in the 1970s and governed at the state level, newborn screening expanded gradually as cost-effective tests developed or new treatments were discovered, and has recently undergone an unprecedented phase of growth and change. While many embrace and encourage these changes, they create a number of dilemmas that must be addressed to ensure that the practice grows in a rational and ethical fashion.