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Biological newborn screening (BNS), known as the “heel prick test,” is a vital public health strategy for the early diagnosis of treatable congenital diseases. This ecological time-series study analyzed BNS coverage in Brazil between 2014 and 2023 based on data from DATASUS. Trends were assessed using Prais-Winsten regression, and the correlation between coverage and indicators such as adequate prenatal care, hospitalizations in children under 1 year of age, mortality, and HDI was verified. National coverage increased from 73.75% to 83.28% (APC = 1.06%). The South region had coverage above 90%, whereas the North had coverage below 70%. There was a strong correlation between coverage and adequate prenatal care (r = 0.93) and a moderate correlation with hospitalizations and neonatal mortality. HDI was not significantly associated. Despite the progress, regional inequalities persist. These findings highlight the need for targeted policies, better integration of health services, and equity-oriented strategies to achieve universal BNS coverage in Brazil.