A nationwide Belgian randomized trial of 567 patients found that genome sequencing diagnosed 39.8% of developmental disorder cases, outperforming the standard combination of exome sequencing and chromosomal microarray. The results strengthen the case for moving from tiered panels to broader sequencing when diagnostic yield is the key endpoint. The trial also underscores how study design is influencing adoption decisions, as cost, turnaround time, and downstream interpretation capacity become central for health systems. For biotech and diagnostics companies, the data point to a continued shift toward whole-genome workflows and emphasizes demand for robust variant interpretation, consent frameworks, and clinical utility evidence.