Facilitators and barriers to expansion of newborn screening programs in the 21st century.

Background – Newborn screening programs have grown over the past 50 years to include screening for more than 40 metabolic and genetic disorders. Technology, or the ability to screen for disorders, is not the sole influence for expansion of screening. The lack of clarity in how facilitators and barriers impact newborn screening programs can affect the stakeholder‟s perspective of public health department initiatives and future goals. While it is important to detect diseases early to optimize the benefits of timely treatment, the process of newborn screening is a complex, multi-level, interrelated decision-making entity. Method – A logic model was developed in order to help stakeholders establish reasonable expectations, while being aware of the delays and unanticipated consequences which might occur when attempting to expand newborn screening programs. Results and Conclusions – The logic model emphasizes that expansion of newborn screening relies on several interrelated factors that can be identified as Technical, Financial, Policy and Human Capital. Further delineating these factors into a series of checklists promises to be of value to decision-makers in state-operated newborn screening programs, given conditions of constrained resources and anticipated barriers.