Using various animal models, studies have greatly expanded our understanding of perinatal hypoxia-induced neuronal injury in the newborn at the cellular/molecular levels. However, the synapse-basis pathogenesis and therapeutic strategy for such detrimental alterations in the neonatal brain remain to be addressed. We investigated whether the damaged synaptic efficacy and neurogenesis within hippocampal CA1 region (an essential integration area for mammalian learning and memory) of the neonatal rat brain after perinatal hypoxia were restored by granulocyte-colony stimulating factor (G-CSF) therapy. Ten-day-old (P10) rat pups were subjected to experimentally perinatal hypoxia. G-CSF (10, 30, or 50 g/kg, single injection/d, P11-16) was s.c. administered to neonatal rats which were analyzed on P17. Perinatal hypoxia reduced the expression in pRaf-pERK1/2-pCREB signaling, the synaptic complex of postsynaptic density protein-95 (PSD-95) with N-methyl-D-aspartate receptor (NMDAR) subunits (NR1, NR2A, and NR2B), synaptic efficacy, and neurogenesis. A representatively effective dosage of G-CSF (30 g/kg) alleviated the perinatal hypoxia-induced detrimental changes and improved the performance in long-term cognitive function. In summary, our results suggest a novel concept that synaptic efficacy defects exist in the neonatal brain previously exposed to perinatal hypoxia and that G-CSF could be a clinical potential for the synapse-basis recovery in the perinatal hypoxia suffers. (Pediatr Res 70: 589-595, 2011) C erebral hypoxia induced by asphyxia episodes during the neonatal period leads to long-term neurologic disabilities varying from mild behavioral dysfunctions to severe seizure, mental retardation, and/or CP among the newborn (1). Studies indicated that transient cerebral hypoxia triggered a series of pathophysiological changes leading, ultimately, to the neurodegeneration in oxygen sensitive so-affected brain regions, including the hippocampus (an important integration area for mammalian cognitive learning and memory) (2-4). Although underlying mechanisms for the neonatal brain following perinatal hypoxia are extensively studied in the past, it remains unclear about synapse-basis pathogenesis and effective drug therapy.Phosphorylation of cAMP-responsive element-binding protein at serine 133 [phosphorylated cAMP-responsive elementbinding protein at serine 133 (pCREB ), a neurotrophic nuclear transcription factor] is involved in the formation of the synaptic complex of postsynaptic density 95 (PSD-95) protein with the N-methyl-D-aspartate receptor (NMDAR) subunit and serves important roles in the neurological regulation of ionchannel function, neuronal differentiation and maturation, synaptogenesis, synaptic plasticity, neuronal survival, and the processes of learning and memory (5-12). Previously, we reported that, using an animal model, experimentally perinatal hypoxia decreased pCREB and PSD-95 expression within the hippocampus (9,13). Thus, it highlights the possibility that such decreased expression co...