About

Scott A. Lorch, MD, MSCE, is the Kristine Sandberg Knisely Professor in Neonatology at the Perelman School of Medicine at the University of Pennsylvania. He is a senior fellow at the Leonard Davis Institute of Health Economics and an associate scholar at the Center for Clinical Epidemiology and Biostatistics, both at the University of Pennsylvania. Dr. Lorch is an attending physician in the Division of Neonatology at the Children's Hospital of Philadelphia, where he also serves as the director of the Neonatal-Perinatal Fellowship Training Program and the director of the Center for NewBORN Epidemiology and Outcomes Research. His clinical expertise is in neonatal-perinatal medicine. His research focuses on health services research, perinatal epidemiology, and health economics, with particular emphasis on understanding why children have different health outcomes. His work involves assessing pediatric and neonatal care quality, examining sociodemographic disparities in health outcomes, and evaluating the organization of perinatal and pediatric care at various levels, including hospital and state levels.

Research topics

• Medicine
• Physical therapy
• Pediatrics
• Internal medicine
• Medical emergency
• Psychiatry
• Family medicine
• Emergency medicine
• Surgery

Selected publications

• Who pays when we don’t pay for pediatric research?

  Pediatric Research · 2026-03-11

  article
  PublisherDOI

• Understanding Postpartum Hospital Use Among Birthing People With Medicaid Insurance

  Obstetrics and Gynecology · 2026-01-22

  article

  Individuals with Medicaid insurance are more likely to have pregnancy-related complications than individuals with private insurance, but previous research has not described postpartum hospital use in the population of patients with Medicaid. Using Medicaid claims data, we analyzed time to the first instance of postpartum hospital use during the postpartum year using Kaplan-Meier curves and described causes of postpartum hospital use at different postpartum windows. Among 1,626,056 birthing individuals, 20.7% had postpartum hospital use at 1 year postpartum. We found a higher proportion of postpartum hospital use after the typical 30-day postpartum analysis window than within the initial 30 days postpartum, with causes of postpartum hospital use shifting away from delivery-related causes over time. This highlights the need to better understand postpartum hospital use in the population of patients with Medicaid insurance, because 40% of births in the United States occur in this population.

  PublisherDOI

• Associations of Community Material Neighborhood Deprivation With the Diagnosis of Asthma Among Infants With Bronchopulmonary Dysplasia (BPD)

  Pediatric Pulmonology · 2026-01-01

  articleOpen access

  OBJECTIVE: To quantify associations of the community-level material deprivation index (CMDI) with asthma diagnosis by age 5 years among preterm infants with bronchopulmonary dysplasia (BPD). METHODS: We conducted a retrospective cohort study of preterm infants with BPD, born between 2010 and 2019, discharged from a single hospital system to a home address in the Philadelphia metropolitan area, with documented follow-up in the Children's Hospital of Philadelphia Care Network through 5 years of age. Patient charts were reviewed for asthma diagnoses, identified by ICD-10 codes. We geocoded each patient's address at time of neonatal intensive care unit (NICU) discharge to assign census tract CMDI values (range 0 to 1). Multivariable logistic regression models quantified associations of CMDI with asthma diagnosis by age 5 adjusting for patient-level factors. RESULTS: Of the 337 preterm infants with BPD and 5-year follow-up within the CHOP Care Network, 169 (50%) were diagnosed with asthma by age 5. CMDI was higher among infants diagnosed with asthma compared to those without asthma (0.43 vs 0.38, p = 0.002). Per standard deviation increment of CMDI, infants had 34% and 32% higher odds of asthma diagnosis in unadjusted (OR 1.34, 95% CI: 1.11, 1.62) and adjusted (aOR 1.32, 95%CI: 1.05-1.65) models, respectively. CONCLUSIONS: Among an urban population of former preterm infants with BPD, high rates of asthma by school age were noted and higher neighborhood deprivation was associated with asthma diagnosis by age 5 years.

  PublisherOA PDFDOI

• Associations of Early Life Ambient PM _2.5 Exposure With Asthma Risk in a Cohort of Preterm Infants With Bronchopulmonary Dysplasia

  Pediatric Pulmonology · 2025-12-01

  articleOpen access

  ABSTRACT Objective To examine whether exposure to fine particulate matter (PM 2.5 ) during the first year after neonatal intensive care unit (NICU) discharge is associated with asthma by age 5 among infants with bronchopulmonary dysplasia (BPD). Methods We conducted a retrospective cohort study of 337 infants with BPD, born between 2010 and 2019, who survived to discharge with clinical follow‐up in the Children's Hospital of Philadelphia Care Network through age 5. Daily residential census block group PM 2.5 exposures were estimated using a spatiotemporal machine‐learning model and averaged over the first year after NICU discharge. Modified Poisson regression models with robust standard errors quantified associations of PM2.5 with asthma by age 5, adjusting for neonatal clinical factors, insurance, neighborhood deprivation, and race/ethnicity. Results By age 5 years, 169 (50.1%) infants had an asthma diagnosis. Mean annual PM 2.5 exposure was 8.8 µg/m 3 (SD 1.1). Each 1 µg/m 3 increment of PM 2.5 was associated with higher asthma risk (unadjusted RR 1.14, 95% CI: 1.03–1.25; fully adjusted aRR 1.19, 95% CI: 1.03–1.37). Compared to the lowest exposure tertile (mean 7.6 µg/m 3 ), adjusted rates of asthma tended to be higher as exposure increased: Tertile 2 (mean 8.7 µg/m 3 , aRR 1.31; 95% CI: 0.98–1.74), Tertile 3 (mean 10.0 µg/m 3 , aRR 1.68, 95% CI: 1.17–2.4). Conclusions Exposure to higher ambient PM 2.5 in the year after NICU discharge was associated with asthma by age 5 among children with BPD. These findings highlight early‐life air quality as a modifiable determinant of long‐term respiratory outcomes in infants with BPD.

  PublisherOA PDFDOI

• Misinformation and disinformation undermine progress in pediatric research: challenges and solutions

  Pediatric Research · 2025-10-06 · 1 citations

  articleOpen access
  PublisherOA PDFDOI

• Optimizing pharmacologic treatment for neonatal opioid withdrawal syndrome (OPTimize NOW): a symptom-based dosing approach study protocol for a multi-center, cluster crossover design randomized controlled trial

  Trials · 2025-08-27 · 2 citations

  articleOpen access

  BACKGROUND: Opioid use and misuse during pregnancy rose from 1.5 to 6.5 per 1000 deliveries between 1999 and 2014 and continues as a significant public health concern. A fivefold increase in neonatal opioid withdrawal syndrome (NOWS) has accompanied the increase in opioid use. The Eating, Sleeping, Consoling care approach (ESC) has been shown to improve outcomes for infants with NOWS and is quickly becoming the standard of care for infants affected by opioid use disorder. Quality improvement initiatives following the implementation of ESC provide some evidence to suggest that symptom-based (i.e., as needed, PRN, just in time) dosing of opioid medications for infants with significant withdrawal may be an effective alternative to using a traditional scheduled opioid taper approach. These initiatives have shown reduced length of hospital stay and decreased postnatal opioid exposure when compared to scheduled opioid dosing for infants with NOWS who receive pharmacologic treatment. It is unknown if the findings from these quality improvement initiatives are generalizable, and little is known about the safety of this approach in a diverse population. The purpose of this manuscript is to describe the design and rationale for an ongoing study to evaluate the effect of symptom-based opioid dosing compared to traditional scheduled opioid taper on short-term outcomes for infants with NOWS. METHODS/DESIGN: In this ongoing multi-center two-period cluster crossover randomized controlled trial, 24 sites within the USA were randomized at the site level into one of two sequences. Prior to randomization, sites were stratified by care approach used (ESC vs. usual care) and these strata were independently randomized. All study sites will provide care based on their random allocation. Data will be collected under waiver of consent for in-hospital and short-term outcomes for eligible infants. A minimum of 480 infants will be enrolled. We hypothesize that use of symptom-based dosing will safely reduce the length of time until infants with NOWS and at risk for pharmacological treatment are medically ready for discharge when compared to infants treated with a scheduled opioid taper. DISCUSSION: This trial is uniquely and efficiently designed to establish the efficacy, safety, and generalizability of the symptom-based dosing approach to opioid treatment for NOWS. TRIAL REGISTRATION: NCT05980260 ; registered July 27, 2023.

  PublisherOA PDFDOI

• Hospital birth volume and rurality: Associations with pregnancy outcomes among individuals with chronic hypertension

  Pregnancy · 2025-09-01

  articleOpen access

  Introduction: Chronic hypertension in pregnancy has doubled in prevalence over the past 15 years, but little is known about pregnancy outcomes at hospitals with different characteristics. We evaluated the association between hospital birth volume and rurality with risk of adverse pregnancy outcomes among individuals with chronic hypertension. Methods: We conducted a population-based study using linked vital statistics and birth hospitalization discharge data from Michigan, Oregon, South Carolina (2008-2020), and Pennsylvania (2008-2018). We classified hospitals based on federal rural-urban county classifications and annual birth volume. The primary outcome was a composite measure of adverse pregnancy outcomes, including superimposed preeclampsia or eclampsia, severe obstetric morbidities, and fetal/neonatal morbidities. We used multivariable modified Poisson regression models with hospital fixed effects and robust standard errors to estimate the risk ratios (RRs) with 95% confidence intervals (CIs) for the primary outcome and the component outcomes for each hospital group compared with high-volume urban hospitals. Results: Among 106,991 births to individuals with chronic hypertension, the crude incidence of the primary adverse pregnancy outcome was highest in high-volume urban hospitals (49.5%) and lowest in low-volume rural hospitals (34.4%). Additionally, a higher proportion of individuals giving birth at high-volume urban hospitals had a high (≥10) obstetric comorbidity score (45% vs. 24-27% at rural and low-volume urban hospitals). After robust adjustment for clinical characteristics in regression models, however, no differences between hospital groups were evident. Among primary outcome components, only the risk of superimposed preeclampsia or eclampsia was higher in low-volume urban hospitals (adjusted RR: 1.21; 95% CI: 1.09-1.34) and medium-volume rural hospitals (adjusted RR: 1.26; 95% CI: 1.05-1.50). Conclusions: Adverse pregnancy outcomes among individuals with chronic hypertension were largely similar across hospital volume and rurality groups, after accounting for differences in case mix. However, superimposed preeclampsia or eclampsia was highest at medium-volume rural and low-volume urban hospitals, suggesting potential opportunities for improved prenatal clinical management of chronic hypertension.

  PublisherOA PDFDOI

• Policy-level solutions to support families experiencing adverse childhood experiences

  Pediatric Research · 2025-08-01

  article
  PublisherDOI

• The Science of Health: Pediatric Research that should have been in the MAHA report

  Pediatric Research · 2025-10-10

  article
  PublisherDOI

• The Impact of Increased Medicaid Eligibility During Pregnancy on Medicaid Utilization and Gestational Age

  Health Services Research · 2025-09-14

  articleOpen accessSenior author

  OBJECTIVE: To assess the impact of increased Medicaid income eligibility during pregnancy on payment source for prenatal care and birth and on gestational age at birth (GAb). STUDY SETTING AND DESIGN: We performed a quasi-experimental, difference-in-differences study comparing two increases in Medicaid income eligibility during pregnancy to two control states with data from 2007 to 2010: (Dyad 1) Ohio (expanded from 150% to 200% of the Federal Poverty level [FPL]) versus Pennsylvania and (Dyad 2) Wisconsin (185% to 250% FPL) versus Michigan. We performed multinomial logistic regression to assess the impact of increased Medicaid eligibility on the following key outcome variables: payment source for prenatal care and birth and GAb. DATA SOURCES AND ANALYTIC SAMPLE: We utilized CDC Pregnancy Risk Assessment Monitoring System (PRAMS) data (2007-2010) and limited analysis to singleton, in-state live births. After re-weighting for PRAMS survey design, our analytical sample represented about 540,000 births. PRINCIPAL FINDINGS: In the higher-income Wisconsin-Michigan dyad, increased Medicaid eligibility during pregnancy significantly increased exclusive Medicaid coverage for prenatal care (7.0%, 95% CI 2.9% to 11.1%) and birth (8.3%, 4.3% to 12.4%). Simultaneously, private insurance coverage dropped for prenatal care (-4.0%, -7.7% to -0.3%) and birth (-3.7%, -7.2% to -0.2%) while self-payment decreased only for birth (-1.8%, -3.5% to -0.2%). In the lower-income Ohio-Pennsylvania dyad, the only statistically significant effects on payment source were decreases in the likelihood of a payment source of other for prenatal care (-3.3%, -6.2% to -0.3%) and birth (-4.7%, -7.9% to -1.6%). There were no statistically significant effects on GAb across both dyads. CONCLUSIONS: Increased Medicaid eligibility during pregnancy for individuals of higher income seems to improve utilization of exclusive Medicaid with diminished uninsurance but also less private insurance after accounting for indicators of socioeconomic advantage but has no clear impact on GAb. Medicaid policy should balance reducing uninsurance with directing scarce resources to high-risk individuals.

  PublisherOA PDFDOI

Recent grants

• Impact of Pediatric Trauma Centers on Outcomes of Injured Children

  NIH · $1000k · 2016–2021

• Predicting and Preventing Pediatric Hospital Readmissions

  NIH · $1.0M · 2015–2020

• NIH Grant R01HS015696

  NIH · $899k · 2011

• NIH Grant U01HL062514

  NIH · $7.6M · 2008

• NIH Grant R01HD057168

  NIH · $3.4M · 2016

Frequent coauthors

• Sara B. DeMauro

  Children's Hospital of Philadelphia

  146 shared

• Molly Passarella

  University of Pennsylvania

  132 shared

• Sara C. Handley

  Children's Hospital of Philadelphia

  104 shared

• Brenda B. Poindexter

  101 shared

• Carla Bann

  97 shared

• Dylan S. Small

  97 shared

• Michele C. Walsh

  Case Western Reserve University

  96 shared

• Namasivayam Ambalavanan

  University of Alabama at Birmingham

  92 shared

Labs

• Neonatology, Division of Neonatology, Department of Pediatrics, Children's Hospital of PhiladelphiaPI

Education

• MSCE, Clinical Epidemiology

  University of Pennsylvania

  2003

• MD

  Northwestern University

  1996

• BA, Political Science

  Northwestern University

  1992