North American Registry of Midwives (NARM) Practice Exam

Which of the following is NOT one of the ways a neonate can create heat?

1. Shivering

2. Voluntary muscle activity

3. Excretory activity

4. Non-shivering thermogenesis

The correct answer is: Excretory activity

A neonate primarily generates heat through mechanisms tailored to their unique physiology. Creating heat is essential for maintaining body temperature, particularly since they are more susceptible to hypothermia in their early days of life. Non-shivering thermogenesis is a crucial method for heat production in neonates. This occurs primarily through the metabolism of brown adipose tissue, which is abundant in infants and activated when they are exposed to cold. The brown fat generates heat without the muscle contractions associated with shivering. Similarly, voluntary muscle activity can lead to heat production, but in the case of neonates, their ability to perform such activities is limited. They have reflexive movements rather than the controlled muscle engagements seen in older individuals, but even these can contribute slightly to heat generation. Shivering, which is a reflex action to generate heat through muscle contractions, is not a mechanism utilized by neonates. Their immature nervous system often lacks the capability to initiate shivering when they are cold. In contrast, excretory activity does not contribute to heat production in any significant way. Thus, labeling it as a method for creating heat recognizes that, unlike the other listed processes, it does not play a role in thermogenesis for neonates.