Meconium aspiration syndrome (MAS) is still one of the most challenged diseases for the neonatologists. We reviewed our earlier studies of MAS in an attempt to provide some idea for more understanding of MAS. This study is a retrospective review and summarization of our earlier studies in MAS at two tertiary neonatal centers in Taiwan. Incidence of MAS was decreased sharply in Taiwan. MAS infants who required resuscitation in the birth room being out-born, birth asphyxia and infants who developed persistent pulmonary hypertension (PPHN) and pneumothrax were associated with increasing mortality. In MAS infants who neither required mechanical ventilation nor had a history suggestive of perinatal infection, antibiotic treatments would not affect the outcome of MAS. Dexamethasone did reduce inflammation response and improve cardiopulmonary perfusion. However, steroids did not prevent the development of PPHN. Our review provided the risk factors of mortality for MAS. Antibiotic treatments should not be a routine for every infant with MAS. Although steroids reduce pulmonary inflammation, their role in the prevention of PPHN remains to be further studied.