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Neonatal neurobehavioral development was investigated in a sample of 20 hospitalized, prenatally cocaine-exposed preterm infants and 20 matched non-exposed controls. Prenatal cocaine exposure was related to reductions in attention performance that remained apparent at 36 wks conceptional age. There was no impact of prenatal cocaine exposure on the rate of change in attention proficiency. In utero alcohol exposure was associated with increased rates of age-related change in motor skill. Alcohol-related performance deficits were transient; alcohol-exposed infants reached an equivalent level of motor performance exhibited by the non-exposed infants by 36 wks conceptional age. These findings highlight the importance of considering potential effects of prenatal cocaine exposure in the context of other substance exposure, and demonstrate the utility of a developmental perspective to address the impact of prenatal substance exposure on outcome.