Aim
The aim of this study was to identify the incidence, risk factors and outcome associated with meconium aspiration syndrome (MAS).

Methods
An observational study was conducted in 12 public hospitals in Nepal from 1 July 2017 to 29 August 2018. All babies born within the study period were included in the study. Babies who were diagnosed as MAS were designated as outcome. Data were analysed with bivariate analysis followed by multiple regression analysis.

Results
The overall incidence of MAS was 2.0 per 1000 livebirths. Babies born at post‐term gestation (adjusted odds ratio (AOR) = 2.41; 95% confidence interval (CI): 1.05–5.55), nulliparity (AOR = 2.26; 95% CI: 1.20–4.28), instrumental delivery (AOR = 4.79; 95% CI: 2.52–9.10) and caesarean delivery (AOR = 3.67; 95% CI: 2.29–5.89) were significantly associated with MAS. Babies with MAS had a 10‐fold risk for pre‐discharge mortality (odds ratio = 9.87; 95% CI: 5.81–16.76).

Conclusions
The findings in this study are consistent with that reported in other studies. MAS has a high risk of neonatal mortality. Thus, monitoring during pregnancy and labour is necessary for early identification of high‐risk conditions associated with MAS. Strengthening of newborn care services is essential to curtail mortality.