Hypoxic-ischemic (HI) injury in the preterm neonate incurs numerous functional deficits, however little is known about the neurochemically-defined brain nuclei that may underpin them. Key candidates are the brainstem catecholamine neurons. Using an immature animal model, the postnatal day (P)-3 (P3) rat pup, we investigated the effects of HI on brainstem catecholamine neurons in the locus coeruleus, nucleus tractus solitarius (NTS), and ventrolateral medulla (VLM). On P21, we found that prior P3 HI significantly reduced numbers of catecholaminergic neurons in the locus coeruleus, NTS, and VLM. Only locus coeruleus A6, NTS A2, and VLM A1 noradrenergic neurons, but not NTS C2 and VLM C1 adrenergic neurons, were lost. There was also an associated reduction in dopamine-beta-hydroxylase-positive immunolabeling in the forebrain. These findings suggest neonatal HI can affect specific neurochemically-defined neuronal populations in the brainstem and that noradrenergic neurons are particularly vulnerable to HI injury. (Pediatr Res 63: 364-369, 2008) P rematurity and hypoxia-ischemia (HI) in newborn infants are critical risk factors contributing to perinatal mortality and neurologic morbidity. Perinatal HI in the preterm neonate can lead to long-term brain injury and a broad range of neurologic deficits that include motor disabilities, autonomic dysfunction, epilepsy, memory, and attention disorders (1,2). Premature neonates are particularly susceptible to white matter injury in the brain. Neuronal injury in the brain also ensues and damage to certain areas of the brain may be associated with neurologic impairments in adults or children who have experienced HI as a neonate. However, very little is known about how perinatal HI affects neurochemically-defined groups of neurons in the immature preterm brain. It is therefore difficult to ascertain which specific brain nuclei and neuronal networks might be responsible for, or at least contribute to, the long-term functional deficits observed and how different neurons vary in their susceptibility to HI injury.Injury to the brainstem after HI may be a critical contributor to autonomic and cardiorespiratory dysfunction in premature infants and neonatal animals (3-5). The brainstem consists of well-defined neurochemical groups of neurons, in particular the catecholamine neurons, serving as critical integratory sites in the brain. Distinct populations of brainstem catecholamine neurons reside in the locus coeruleus (A6 noradrenergic neurons), nucleus tractus solitarius (NTS) (A2 noradrenergic and C2 adrenergic neurons), and ventrolateral medulla (VLM) (A1 noradrenergic and C1 adrenergic neurons). These neuronal populations constitute the major sources of noradrenergic and adrenergic networks in the brain. The NTS and VLM catecholamine neurons, located in the medulla oblongata, have major roles in cardiovascular and respiratory control mechanisms, gastrointestinal, vasomotor tone, and neuroendocrine regulation (6,7). The locus coeruleus A6 noradrenergic neurons in the pont...