Exposure to preconditioning (PC) hypoxia 24 h before a severe hypoxic-ischemic (HI) insult reduces development of injury in the immature brain. Several protective regimens have proved effective in the short-term but not in the long-term perspective. The aim of the present study, therefore, was to evaluate the PC effect on long-term morphologic and neurologic outcome in the developing brain. Six-day-old rats were subjected to hypoxia (36°C, 8.0% O 2 ; PC/HI group) and sham controls to normoxia (36°C; HI group) for 3 h. Twenty-four hours later, all rats were exposed to cerebral HI produced by unilateral carotid artery occlusion combined with 1 h, 15 min of hypoxia (36°C, 7.7% O 2 ). A cylinder test was used to evaluate forelimb asymmetry to determine sensorimotor function at 4, 6, and 8 wk of age. Spatial/cognitive ability was assessed by Morris water maze trials at 7 wk of recovery. Neuropathologic analysis was performed 8 wk after insult. Brain damage was reduced (p Ͻ Hypoxic-ischemic (HI) brain injury during the perinatal period is a major cause of lifelong disability (1,2). The development of effective therapeutic and/or preventive strategies to treat these pathologic events relies on a better understanding of the critical pathophysiologic events that lead to HI brain injury.In 1986, Murry et al. (3) reported that the extent of myocardial infarction resulting from a sustained coronary occlusion was diminished when the heart had been subjected to brief periods of sublethal ischemia. The protection elicited by a previous sublethal intervention that renders the tissue less sensitive to a subsequent insult has been termed preconditioning (PC). PC can be induced in the CNS through a variety of exposures, for example, seizures (4), hypoxia (5), lipopolysaccharide (6), and mitochondrial toxins (7).A PC model has been developed for the immature brain, whereby exposure to 8% hypoxia 24 h before severe HI reduces injury by 70 -100% (5,8,9). Findings of protection have been demonstrated from 1 to 3 wk after insult. Recent studies indicate, however, that development of injury in the immature brain after HI may be delayed for up to 8 wk (10), and in some cases, the salutary effects of PC in the adult (11) are partly lost after long recovery periods after the severe insult. A number of treatments after HI in immature animals have also been shown to delay injury rather than provide a permanent protection (12). Furthermore, deficits in spatial/ cognitive and sensorimotor functions sometimes occur despite no or subtle brain injury, implicating the need for sophisticated functional assessments as a complement to evaluation of lesion size (13). Our aim, therefore, was to further characterize PC in the immature brain and to determine to what extent hypoxic PC provides long-lasting behavioral and histologic protection.