Background: Meconium-stained amniotic fluid (MSAF) is the result of passage of meconium in utero by the fetus antenatally or during labor process. However, MSAF is considered an alarming sign of fetal compromise and its occurrence is associated with a poor perinatal outcome. There is growing evidence that indicates its association with increased incidences of meconium aspiration syndrome (MAS), operative delivery, respiratory distress, neonatal sepsis, need for resuscitation, neonatal intensive care admission, and low Apgar score. MAS remains a serious problem in developing and newly industrialized countries, and MAS accounts for about 10% of all cases of respiratory failure with 25-39% mortality rate. Methods: This hospital-based cohort study was conducted in NICU of Paediatrics department of our hospital over two years from July 2019 to June 2021 including live newborns of gestational age >35 weeks born with MSAF and with no congenital anomalies. Clinical profile, risk factors and immediate neonatal outcome of such neonates was studied. Result: Out of 984 live births, 159 neonates were found to be born with MSAF, taking the incidence to 16.1%. Out of these, 24 (15.1%) suffered from MAS. 11 (45.8%) had features of mild MAS, 5 (20.8%) had moderate MAS while 8 (33.33%) had severe MAS. Mean birth weight of neonates born with MSAF was 3.24 kg ± 0.39 Kg, range: 1.87-4.46 kg. Low APGAR score, non-reassuring CTG, requirement of resuscitation, requirement of endotracheal suction, requirement of oxygen support, incidence of MAS and mortality were significantly associated with thick as compared to thin meconium-stained liquor. Overall, 19 (11.84%) neonates with MSAF and 5 (20.8%) neonates with MAS couldn’t survive. Conclusion: The presence of MSAF at delivery is an indicator of probable foetal compromise. MSAF is usually associated with several maternal and neonatal risk factors. Meconium aspiration syndrome is the most severe complication of MSAF that contributes significantly to neonatal morbidity and mortality.