RNC-NIC COMPLETE STUDY GUIDE
QUESTIONS AND SOLUTIONS 2026
◉ frequent tracheostomy plugging. Answer: - *may indicate more
humidity is needed in the system*
◉ neutral thermal environment. Answer: - *the environmental
temperature at which the individual infant utilizes the least amount
of energy and consumes the least amount of oxygen while
maintaining a normal core body temperature that is needed for
optimal growth and development*
- *results in minimal heat production and oxygen consumption while
still maintaining a core temperature that is within normal limits*
◉ why newborns are at greater risk of hypothermia. Answer: -
*newborns have an increased surface area: body weight ratio --> a
MAJOR cause of heat loss for babies*
- also poorly developed autonomic thermoregulatory response
- inability to shiver to produce heat
- increased percentage of body weight as water and increased
permeability of the skin result in greater evaporative heat loss
◉ infants most at risk for hypothermia. Answer: - **any infant that is
stressed!**
,- apnea, hypothermia, hypoglycemia are the first 3 presenting signs
of many issues in neonates
◉ ways infants produce heat. Answer: - *non-shivering (chemical)
thermogenesis (primary mode)
- voluntary muscle tone
- shivering (very limited ability in newborns, absent in preemies)
◉ chemical thermogenesis. Answer: - cold stress --> stimulation of
skin receptors --> cold stress stimulus send to the hypothalamus -->
*release of norepinephrine from the sympathetic nervous system* --
> brown fat metabolism --> chemical breakdown of TG in brown fat -
-> glycerol and non-esterified fatty acids
- Non-esterified fatty acids --> circulation, oxidized, re-esterified into
TG
◉ what happens once the brown fat is used up in infant
thermogenesis?. Answer: - infants must rely on *gluconeogenesis*
- gluconeogenesis plays a major role in energy stabilization
- turns proteins and fats into glucose
- this process if mediated by the anterior pituitary gland and cortisol
,◉ conduction. Answer: - method of heat loss in infants in which
there is a *transfer of heat from a warm surface to a cold surface*
(heat --> SURFACE)
- depends on: solid surface conductivity (e.g. metal is more
conductive than plastic), the amount of surface area between the
two objects, temperature gradient between the two objects
- examples: infant placed on a cold scale or on cold sheets, infant
placed on a cold x-ray plate
- prevention: place a warm blanket on the scale or x-ray plate, use a
built-in scale or x-ray tray, pre-warm the bed, warm the
stethoscope/hands
◉ convection. Answer: - method of heat loss in infants in which
there is a *transfer of heat to the cold air of the environment* (heat -
-> AIR)
- depends on: air current velocity, the amount of skin exposed to the
air, temperature gradient between the air and the skin
- examples: infant in a drafty area or cool room temperature, infant
in an open radiant warmer
- prevention: place infant in an incubator, keep room warm
(especially ORs and delivery rooms), clothe baby and put on hat, use
warm/humidified O2
◉ evaporation. Answer: - **#1 mode of heat lose for preemies in the
first week of life**
, - method of heat loss in infants in which there is a *transfer of heat
through WATER loss*
- *preemies are at most risk because of their thin stratum corneum
layer of skin*
- depends on: the baby's surface area, vapor pressure, air current
velocity
- examples: wet infant (immediately after birth), infant on a wet
surface (i.e. blankets), extremely immature infants with
transepidermal water losses
- prevention: dry infant (use warm, dry blankets), use a cotton hat
and clothing, use saran covering and skin barrier creams, high
humidity environment, careful bathing (delay initial bath for 2-4
hours)
◉ radiation. Answer: - **#1 mode of heat loss for preemies AFTER
the first week of life**
- method of heat loss in infants in which there is a *transfer of heat
between two objects that DO NOT TOUCH each other*
- examples: *infant's bed near a cold window (this is NOT convection
because the window is NOT open!!)*
- prevention: careful crib placement, cover crib/incubator with
blanket
◉ considerations for thermoregulation when using
incubator/radiant warmer. Answer: - *Servo control (baby mode)
QUESTIONS AND SOLUTIONS 2026
◉ frequent tracheostomy plugging. Answer: - *may indicate more
humidity is needed in the system*
◉ neutral thermal environment. Answer: - *the environmental
temperature at which the individual infant utilizes the least amount
of energy and consumes the least amount of oxygen while
maintaining a normal core body temperature that is needed for
optimal growth and development*
- *results in minimal heat production and oxygen consumption while
still maintaining a core temperature that is within normal limits*
◉ why newborns are at greater risk of hypothermia. Answer: -
*newborns have an increased surface area: body weight ratio --> a
MAJOR cause of heat loss for babies*
- also poorly developed autonomic thermoregulatory response
- inability to shiver to produce heat
- increased percentage of body weight as water and increased
permeability of the skin result in greater evaporative heat loss
◉ infants most at risk for hypothermia. Answer: - **any infant that is
stressed!**
,- apnea, hypothermia, hypoglycemia are the first 3 presenting signs
of many issues in neonates
◉ ways infants produce heat. Answer: - *non-shivering (chemical)
thermogenesis (primary mode)
- voluntary muscle tone
- shivering (very limited ability in newborns, absent in preemies)
◉ chemical thermogenesis. Answer: - cold stress --> stimulation of
skin receptors --> cold stress stimulus send to the hypothalamus -->
*release of norepinephrine from the sympathetic nervous system* --
> brown fat metabolism --> chemical breakdown of TG in brown fat -
-> glycerol and non-esterified fatty acids
- Non-esterified fatty acids --> circulation, oxidized, re-esterified into
TG
◉ what happens once the brown fat is used up in infant
thermogenesis?. Answer: - infants must rely on *gluconeogenesis*
- gluconeogenesis plays a major role in energy stabilization
- turns proteins and fats into glucose
- this process if mediated by the anterior pituitary gland and cortisol
,◉ conduction. Answer: - method of heat loss in infants in which
there is a *transfer of heat from a warm surface to a cold surface*
(heat --> SURFACE)
- depends on: solid surface conductivity (e.g. metal is more
conductive than plastic), the amount of surface area between the
two objects, temperature gradient between the two objects
- examples: infant placed on a cold scale or on cold sheets, infant
placed on a cold x-ray plate
- prevention: place a warm blanket on the scale or x-ray plate, use a
built-in scale or x-ray tray, pre-warm the bed, warm the
stethoscope/hands
◉ convection. Answer: - method of heat loss in infants in which
there is a *transfer of heat to the cold air of the environment* (heat -
-> AIR)
- depends on: air current velocity, the amount of skin exposed to the
air, temperature gradient between the air and the skin
- examples: infant in a drafty area or cool room temperature, infant
in an open radiant warmer
- prevention: place infant in an incubator, keep room warm
(especially ORs and delivery rooms), clothe baby and put on hat, use
warm/humidified O2
◉ evaporation. Answer: - **#1 mode of heat lose for preemies in the
first week of life**
, - method of heat loss in infants in which there is a *transfer of heat
through WATER loss*
- *preemies are at most risk because of their thin stratum corneum
layer of skin*
- depends on: the baby's surface area, vapor pressure, air current
velocity
- examples: wet infant (immediately after birth), infant on a wet
surface (i.e. blankets), extremely immature infants with
transepidermal water losses
- prevention: dry infant (use warm, dry blankets), use a cotton hat
and clothing, use saran covering and skin barrier creams, high
humidity environment, careful bathing (delay initial bath for 2-4
hours)
◉ radiation. Answer: - **#1 mode of heat loss for preemies AFTER
the first week of life**
- method of heat loss in infants in which there is a *transfer of heat
between two objects that DO NOT TOUCH each other*
- examples: *infant's bed near a cold window (this is NOT convection
because the window is NOT open!!)*
- prevention: careful crib placement, cover crib/incubator with
blanket
◉ considerations for thermoregulation when using
incubator/radiant warmer. Answer: - *Servo control (baby mode)
