A review of the Apgar score indicated that contextualization was required within the contemporary perinatal and neonatal care framework in different settings

J Clin Epidemiol. 2005 Feb;58(2):121-9. doi: 10.1016/j.jclinepi.2004.04.012.


Objective: To triangulate the Apgar score by using a crossdisciplinary approach and highlighting the differences that exist between actual everyday practice and accepted standards of scoring in contrasting populations of the world.

Study design and setting: Clinimetrics review of Apgar scoring.

Results: The Apgar scoring has weighting problems, rigid categorization, redundancy and subjectivity in its variables. Poor inter-rater reliability and equivocal validity mark its use in the present milieu. The ceiling and floor effects further hamper the evaluative responsiveness of scoring. Moreover, despite some recent evidence in its favor, the Apgar score has poor calibration when used as an isolated criterion to predict mortality and long-term morbidity, particularly in preterms. Also, the vigor of resuscitation (nature and duration), in essence, is beyond the realm of the Apgar score in contemporary resuscitation guidelines. In developed nations, with rapidly decreasing age of viability, and alternative modes of childbearing, threats to Apgar are more ominous today than before. On the other hand, in developing countries, feasibility problems due to unattended home deliveries and barriers to effective scoring in the overburdened and understaffed hospitals cast doubts about its accuracy as a measure of neonatal well-being.

Conclusion: Use of the Apgar score definitely needs to be contextualized within the contemporary perinatal and neonatal care framework in different settings.

Publication types

  • Review

MeSH terms

  • Apgar Score*
  • Female
  • Humans
  • Infant Mortality*
  • Infant, Newborn
  • Morbidity
  • Perinatal Care / statistics & numerical data*
  • Pregnancy
  • Pregnancy Outcome
  • Sensitivity and Specificity