Review of the Reliability and Validity of the Apgar Score

Alexandra Michel, Pamela A. Harris-Haman

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: The Apgar score is the most common score used to quantify neonatal status after birth. It is routinely used in clinical practice and research. However, since its introduction there have been significant changes in peripartum and neonatal management, our understanding of neonatal physiology, and changes in data analysis capabilities. Purpose: To assess the Apgar score's reliability and validity in the context of today's clinical and research environments. Method: PubMed was searched using the term "Apgar." Just over 22,000 titles were identified. Full-text articles were obtained if they addressed the Apgar score's use, reliability, and validity, or if the score was a primary outcome measure. This was followed by a hand search using the same criteria. The 505 identified articles build the basis for this discussion of the Apgar score's reliability and validity. Findings: Multiple positive and negative aspects of the Apgar score's reliability and validity were identified. Some facets needed to evaluate reliability and validity do not seem to have been addressed in the literature. Overall, the identified concerns can introduce bias into outcomes obtained via the use of the Apgar score in both clinical practice and research. Implications for Practice: The Apgar score is no longer used to determine neonatal management in the delivery room. Implications for Research: The use of the Apgar score in research may introduce bias into outcomes. As discussed in the Video Abstract, researchers need to address and improve the score's weaknesses or consider developing a new tool better suited to today's research needs. Video Abstract available at:

Original languageEnglish (US)
Pages (from-to)28-34
Number of pages7
JournalAdvances in Neonatal Care
Issue number1
StatePublished - Feb 1 2022
Externally publishedYes


  • Apgar
  • Apgar score
  • assessment
  • neonatal
  • newborn
  • reliability
  • validity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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