Meconium aspiration syndrome (MAS) and its associated complications are reviewed from the period before the routine use of intubation and suctioning to the present (1973 through 1987). Of the 176,790 neonates born during this period, the amniotic fluid was stained in 21,472 (12.15%). Subsequently, MAS developed in 1162 (5.41%) of the meconium-stained neonates. Male neonates were more prone to the disorder than female neonates (P = .022). There were no racial predilections for MAS. The incidence of MAS significantly decreased during the 15 years (P = .043). Of the neonates with MAS, 49 (4.22%) died as a direct consequence of the disorder. The death rate significantly declined during the study period (P = .041). Of the neonates with MAS, 345 (29.7%) required mechanical ventilation, and 134 (11.53%) had pneumothoraxes. Among neonates with MAS, the requirement for mechanical ventilation, as well as the incidence of pneumothoraxes, did not decrease from 1973 through 1987. The incidence of MAS has declined since the advent of combined obstetric and pediatric suctioning of the oropharynx and trachea. Furthermore, there are significantly fewer deaths from the disorder. These declines were likely influenced by other improvements in perinatal care, which have occurred since the early 1970s. The results do not support the contention that severe MAS and resultant deaths can be prevented altogether.