Classic galactosemia is caused by impaired galactose-1-phosphate uridyltransferase (GALT EC 2.7.712). If discovered and treated within the first days of life, the acute problems of hepatocellular damage, sepsis, and death are prevented. However, chronic problems such as ataxia, tremor, dyspraxic speech, and ovarian failure may occur. To determine whether screening newborns before discharge from the nursery for GALT deficiency is feasible and whether acute and chronic signs could be prevented by earlier intervention, we developed a simplified "breath test." We quantitated total body oxidation of 13 C-D-galactose to 13 CO 2 in expired air by normal newborns between 2 h and 2 mo of age and compared their results to older children with GALT deficiency. We found no differences in total body galactose oxidation (TBGO) among normal newborns up to 48 h of age, but a 2-fold rise in TBGO developed during their first 2 wk of life. Older children with galactosemia had significantly less oxidative capacity than normal newborns. We conclude that newborn breath testing for total body galactose oxidation is feasible before discharge from nursery. It has potential utility for both preventing acute neonatal toxicity and determining the mechanisms producing long-term complications such as ovarian failure, dyspraxia, ataxia, and tremors. C lassic galactosemia is an autosomal recessive disorder caused by a deficiency of galactose-1-phosphate uridyltransferase (GALT EC 2.7.7.12). The biochemical phenotype is characterized by accumulation of galactose, galactose-1-phosphate, and galactitol in cells, and of excess excretion of galactitol and galactose (1-4). The disease incidence is approximately 1:30,000 live births in the United States (2). If untreated in the first 2 wk of life, poor feeding, jaundice, hepatic failure, Escherichia coli sepsis, and death may occur. We have personal experience with families whose newborns had died (http://www.savebabies.org/diseasedescriptions/galactosemia. php, formally known as, "Tyler for Life Foundation" and personal experience).Despite population-based newborn screening and dietary intervention within 2-3 wk of life, the clinical outcome of patients with classic galactosemia is variable. Long-term complications include premature ovarian failure, dyspraxic speech, short stature, learning disabilities, and cataracts (5-7). In one ex post facto study, outcome was not related to time of treatment (5).Most states in the United States screen for galactosemia by the Beutler Method, which measures GALT in dried blood on filter paper through enzyme-linked fluorescence of NADPH production from glucose-1-phosphate. Some states use total galactose quantization (8,9). The median time for results to be received by a referring physician from public health laboratories is poorly documented nationally but from personal experience varies between 4 and 30 d (9).It is not clear whether this prolonged exposure to excess galactose-1-phosphate produces the chronic effects of galactosemia during fetal developm...