Genomic newborn screening is at a pivotal moment as healthcare systems transition from research and pilot programmes to clinical implementation. This session will explore the opportunities and challenges of integrating genomic sequencing into newborn screening, including decisions about which conditions to screen for, how to manage uncertain or incidental findings, and the responsibilities for long-term follow-up and care. Drawing on experiences from programmes at different stages of implementation, speakers will share practical lessons and discuss how international collaboration and emerging standards can support equitable, effective, and sustainable genomic newborn screening across diverse health systems.