How a baby with classic galactosemia was nearly missed: When the test succeeds but system fails

Newborn screening (NBS) is a well‐established state‐run public health program which has targeted the early identification of treatable diseases like classic galactosemia (CG) for over a decade. We describe the case of a symptomatic newborn with CG and an abnormal screen report, including positive DNA‐based test, who still managed to fall through the cracks in a sub‐optimally functioning NBS program, despite decades of screening experience. While much attention is paid to testing technology, this case illustrates basic minimum requirements a newborn screening program must fulfill to reliably identify and treat all affected individuals including minimum reporting requirements, case surveillance and a dedicated short‐term follow‐up program. In newborn screening, success is systematic.