Meconium aspiration syndrome (MAS) is a common neonatal problem and, sadly, results in acute and chronic respiratory morbidity. Although meconium aspiration can occur prior to delivery even in the absence of labour, in many infants this condition could be prevented by appropriate suctioning at birth. More accurate prediction of high risk patients and greater use of amnioinfusion may further reduce the occurrence of MAS. In infants with severe respiratory failure both high frequency ventilation and extracorporeal membrane oxygenation have a role. The place for either steroid or exogenous surfactant therapy in MAS remains to be defined.