Aspiration of meconium before or during birth may obstruct airways, interfere with gas transfer and cause rspiratory distress. Recongnition of meconium aspiration pneumonia in X-ray with perinatal and obsterical history as cause of early neonatal pespiratory distress is very important for determine the prognosis. So the authors analyze the 43 cases of neonatal aspiration pnuemonia and their manifestations. The results are as follows: 1. The number of observed patients was 43 cases; 26 cases in male, 17 cases in female. 2. Average gestational week was 41.4 weeks and average birth weight was 3130 gm. 3. Meconium was stained in body and/or cord in 42 cases (98%) and suctioned from trachea in 31 cases (91%). 4. X-ray of chest showed clear lung in 13 cases (30%) and focal or diffuse area of consolidation of variable degree in 30 cases (70%) The pattern of consolidation was reticulogranular (56%) coarse irregular (30%) or atelectasis (7%) and clearing of consolidation was often manifestated within 24 hours in 13 cases (43%). 5. Evidence of pneumomediastinum or pneumothorax was present, in 10 cases (23%). 6. Pleural effusion was also noted in 21 cases (44%)