> 200 unique variants were identified in ~ 700 patients NBS screen positive for VLCADD.
Carrier status was the most common NBS outcome.
8 VUSs were reclassified to likely pathogenic using in silico approaches.
~ 10% of NBS screen positive patients had at least one copy of the p.V283A allele.
7 unrelated homo p.V283A patients had mild or no clinical findings early in life.