We describe a method for more accurately determining residual biotinidase activity in sera of individuals with profound biotinidase deficiency. Using this method we found that there is a statistically significant difference in the means of residual serum enzyme activities of symptomatic children and those identified by newborn screening. A subgroup of children identified by screening have activities higher than any of the symptomatic population. These children may develop mild symptoms, may develop symptoms later in life, or may not develop symptoms at all.