Purpose: State newborn screening programs are rapidly expanding with the inclusion of a large number of uncommon conditions. There remains significant uncertainty about many aspects of these conditions including their natural history, variability, treatment modalities being used, genotype-phenotype correlations, developmental outcomes, effect on families, and costs of care, among others. Data on these important outcome variables are not collected systematically through state programs. Recently, the American Academy of Pediatrics and the federal Health Resources and Services Administration have promoted the development of a data collection system on the long-term outcomes of children with conditions identified through newborn screening. This article provides an overview of the justification for such a system and recommendations for a design. Methods: Recommendations were developed through a multidisciplinary collaboration of regional and national scholars supported through a Health Resources and Services Administration funded project. Results: We propose a registry system with data inputs from subspecialists, the Medical Home, families, and schools. Further, the proposed system would utilize emerging communication technology to provide an interactive web-based system to support families and professionals in their care of children with these complex conditions. Genet Key Words: registry, newborn screening, informatics, public health N ewborn dried bloodspot screening (NDBS) programs are state-based systems for early identification of children affected with heritable and congenital conditions. In recent years, programs have expanded rapidly due to the implementation of new screening technologies, primarily tandem mass spectroscopy. The state-based organization of these public health programs has led to a wide variation from state to state in many aspects of the programs. 1 Although most programs provide short-term follow-up of out of range results to assure that a diagnosis has been made and treatment initiated, there have been only limited efforts to conduct long-term surveillance of children with detected disorders within state programs. A recent study by Hoff et al. 2 found that 56% of NDBS programs responded that they collected no long-term follow-up (LTFU) data. More than two-thirds of state programs employed little or no use of LTFU data. When LTFU data were collected, states report using the information to track the clinical outcome of patients, track the number of individuals lost to follow-up, evaluate the performance of care providers, assess the needs of families, and to conduct research. 2 Hoff et al. 3 also identified several barriers to LTFU data collection, including lack of quality assurance practices, outsourcing of program components, funding constraints, and communication challenges with care providers for affected children.The surveys by Hoff et al. 2,3 help confirm what is common knowledge in the field, that is, most states do not systematically collect information on the longer-term outcomes o...