Fetal or early postnatal stressors may predispose infants to develop diabetes, metabolic syndrome, or stroke. We hypothesized that postnatal stress will predispose animals to develop metabolic syndrome and impair the physiologic response to hypoxic-ischemic brain injury. We characterized the short-and long-term physiologic responses to postnatal stress by examining corticosterone (CS), glucose metabolism, and brain injury in neonatal and adult rats exposed to hypoxiaischemia (H-I). Rat pups were divided into three levels of postnatal stress from postnatal day (P) 3 to P7. All rats underwent unilateral brain injury on either P7 or P134. We measured brain injury, growth, blood pressure, urine/plasma CS, plasma leptin, insulin, and glucose before and after H-I. Postnatal stress increased neonatal CS production, exacerbated neonatal white matter injury, and was associated with adult hyperglycemia after H-I despite increased insulin production. There were no group differences in adult weight, blood pressure, or leptin. Postnatal stress exacerbated brain injury and produced adult hyperglycemia, triggered after hypoxia exposure, consistent with the hypotheses that neonates exposed to early stress are more vulnerable to hypoxia and may be predisposed to develop metabolic syndrome in adulthood. Prolonged maternal separation produced more hyperglycemia than did brief daily handling. (Pediatr Res 66: 278-282, 2009) P rolonged hospitalization in a neonatal intensive care unit is stressful because preterm infants experience prolonged isolation, gavage feedings, and multiple painful procedures. These postnatal stressors may perturb early brain development and permanently impact brain function by affecting neuronal apoptosis, neurogenesis, synaptogenesis, or vascular development. For example, neonatal isolation permanently impairs hippocampus-dependent learning and memory (1), promotes depression (2), and disrupts fear conditioning in rats (3). In addition, because prenatal events can exacerbate neonatal brain injury (4), it is possible that postnatal stress may also exacerbate neonatal H-I. Surprisingly, it is still unknown whether postnatal stress has acute or lasting effects on physiologic responses to H-I.Heart disease, cerebrovascular disease, and diabetes are among the top causes of death in the United States (CDC), and these disease processes can be influenced by early life experiences. The observation that diabetes is more prevalent in infants born to diabetic mothers (5-7) has prompted the development of models of gestational diabetes. A variety of experimental manipulations find that prenatal hyperglycemia leads to abnormal glucose homeostasis in the adult animal (8 -11). Moreover, experimental IUGR produces defects in insulin secretion and hyperglycemia in the exposed adult rats (12,13). The fact that prenatal exposure to dexamethasone increases fetal hepatic glucocorticoid receptor expression and produces adult hyperglycemia in rats strongly suggests that fetal stress may program adult function (14). Alth...