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Since the introduction of the Guthrie test in the 1970s, millions of babies have been screened for inborn errors of metabolism. Technological advances in the automated devices used to puncture the heel ensures that they are "safe" in so far as the depth of incision is controlled, eliminating damage to the calcanaus bone. However, the choice of automated or manual device used by midwives is arbitrary and not supported by research findings. The procedure used by midwives today is similar to that issued when the Guthrie test was first introduced despite research findings which contradict parts of the procedure. There is also evidence that the number of insufficient samples have been on the increase since 1998. This, coupled with the need for more blood since the introduction of cystic fibrosis screening in Scotland, points to the need for evidenced-based practice being applied to the newborn bloodspot screening test. [ABSTRACT FROM AUTHOR]