Goldenbey and Sharp discuss the ethical hazards and programmatic challenges of genomic newborn screening (NBS). They conclude that these ethical and practical concerns highlight how the use of genomic technologies poses a significant threat to state NBS programs, as these programs move ever further from their core protectionist mission. In this regard, the use of genome sequencing methods in state NBS programs may undermine the child welfare goals on which mandatory NBS programs are founded. As the ability to interpret data generated by next-generation sequencing increases, ongoing dialogue among screening programs, genome scientists, primary care physicians, and parents will be essential for assessing where, and how, these technologies should be used. Even though the implementation of genomic technology may improve the quality of NBS, premature adoption of these tools could ultimately place children at risk.