Purpose: The objective of the study was to assess the effectiveness of neonatal mandibular distraction in treatment of obstructive sleep apnea in the perinatal period in preventing a tracheotomy. Methods: This was a prospective study of 15 infants at two centers with severe micrognathia who demonstrated obstructive sleep apnea refractory to conservative therapy. Age at surgery varied from 5-120 days. Distraction was performed at a rate of 2 mm a day. Following distraction, callus consolidation was allowed for four to six weeks and the device removed. Each child underwent a 3-D CT scan 3 months following surgery. Results: Of the 15 patients, 14 successfully underwent extubation and demonstrated significant improvement in the obstructive sleep apnea. Postoperative horizontal ramus length increased to 34.8 mm from 23.3 mm preoperatively. Mean maxillary mandibular discrepancy was 8.28 mm pre-operatively, and 2.2 mm post-operatively. In 6 infants pre and postoperative polygraphic studies showed improvement in obstructive apnea.Conclusion: Neonatal distraction is an effective method for treatment of micrognathia with obstructive sleep apnea in the perinatal period in preventing a tracheotomy