The nurse assesses a preterm infant in the NICU. What signs should be reported to the physician? (Select the 3 correct answers.)

Choice A rationale Superficial scalp veins are a normal finding in preterm infants due to their thin skin and minimal subcutaneous fat, which allows underlying structures, including the veins, to be easily visible. This anatomical feature is expected in a preterm infant and does not typically indicate a pathological process or require immediate reporting to the physician. Choice B rationale Vomiting, especially persistent or projectile, in a preterm infant is a concerning sign. It can indicate various serious conditions, including feeding intolerance, necrotizing enterocolitis (NEC), increased intracranial pressure (IIP), or systemic infection (sepsis). It disrupts fluid and electrolyte balance and requires immediate medical evaluation to determine the underlying cause. Choice C rationale Bulging fontanelles are a critical sign suggestive of increased intracranial pressure (IIP), possibly due to intracranial hemorrhage (ICH), meningitis, or hydrocephalus. Preterm infants, especially those with low birth weight, are at high risk for ICH. This neurological sign necessitates immediate reporting and further investigation to prevent severe brain injury. Choice D rationale Transparent skin is an expected characteristic of a very preterm infant because of the immaturity of the dermal layers and lack of subcutaneous fat, which allows a clear view of the underlying blood vessels. While a marker of prematurity, it is a normal physical assessment finding for this gestational age and is not an acute sign requiring reporting. Choice E rationale Paleness, or pallor, in an infant can be an alarming sign of anemia (due to blood loss or hemolysis), hypoxia, hypoperfusion (shock), or severe infection. Given the vulnerability of preterm infants, paleness suggests a serious underlying physiological compromise affecting oxygen-carrying capacity or tissue perfusion, which warrants immediate reporting.