Introduction: Meconium Aspiration syndrome forms one of the common causes of respiratory distress in the newborn presenting with complications ranging from mild transient tachypnea to respiratory failure. This study analyzed newborns delivered in Nalanda Medical College and Hospital, Patna over the period of 3 months. Objective: To know the incidence, clinical profile and associated risk factors of developing meconium aspiration syndrome in neonate delivered through meconium stained amniotic fluid (MSAF). Material and Methods: 1196 live newborn babies delivered during the study period from July 2019 to September 2019 were enrolled in this study and assessed accordingly. Result: During the present study, out of 1196 deliveries, 176 (14.7%) neonates were found to be born through MSAF. 76% of the babies born out of MSAF in our study had birth weight between 2.5 – 3.5 kg. Incidence of perinatal asphyxia among MSAF cases was 70.4%. It our study, 15.3% cases of MSAF developed MAS. Incidence of MAS was 2.2% out of total delivery in our hospital. Tachypnea and grunting were present in all cases of MAS. Out of 27 cases of MAS, 7 improved with CPAP, whereas 6 needed mechanical ventilation. Mortality among MAS was 14.8% in present study. Conclusion: Meconium Aspiration Syndrome was the common cause of respiratory distress in neonate. Term and post terms, birth weight >2.5 kg, appropriate and large for gestational age, APGAR score <7, Oligohydramnios are some of the risk factors for developing meconium aspiration syndrome according to our study. It is concluded that good perinatal management can reduce the incidence of perinatal asphyxia and thus the complications of meconium aspiration syndrome to a great extent.