Introduction: Meconium aspiration syndrome is a serious condition in which a newborn breathes a mixture of meconium and amniotic fluid into the lungs. These infants are at risk of meconium aspiration pneumonia and must be observed closely for respiratory distress.

Materials and Methods: An observational study was conducted at Pokhara Academy of Health Sciences from 15 January 2022 to 16 November 2022. One hundred and fifty five babies born through the meconium-stained amniotic fluid within the study period were included in the study. Eighty four babies were diagnosed with meconium aspiration syndrome out of these babies. Data were analyzed with bivariate analysis.

Results: The incidence of meconium aspiration syndrome was 11.8 per 1000 live births. 61.3% of babies born through meconium-stained amniotic fluid were post-term. Spontaneous vaginal delivery increased the risk of meconium aspiration syndrome (OR = 3.86; 95% CI: 1.84–8.09). The thick consistency of meconium, Apgar scores less than 7 at 1 and 5 minutes, and need for resuscitation at birth increased the risk. It had a twofold risk for pre-discharge mortality (odds ratio = 2.06; 95% CI: 1.735–2.44). Factors associated with mortality were small for gestation age, APGAR less than 7 at 1 and 5 minutes, Downe score of ≥ 4, and the need for resuscitation and mechanical ventilation.

Conclusion: Meconium aspiration syndrome has a high risk of neonatal mortality and morbidity. Monitoring during pregnancy and labour is crucial for identifying high-risk conditions. Newborn care plays an important role to reduce neonatal mortality.

Keywords: meconium aspiration syndrome, meconiumstained amniotic fluid, respiratory distress