Sex-Based Differences in Long-Term Lipid Metabolism, Inflammation and Stress Regulation After Non-Severe Paediatric Burns

Paediatric burn injuries are a global health concern with long-term health consequences, such as psychological, immune, and cardiovascular complications, that can persist even after non-severe injuries. Emerging evidence suggests that biological sex may influence post-burn outcomes in children, as female burn survivors have been shown to experience higher mortality, scarring, anxiety, depression, and poorer quality of life compared to males. This study addresses a critical research gap by examining sex-specific lipidomic and inflammatory responses following paediatric non-severe burn injury. Children under five years were recruited as a part of the Childhood Burn Injury Biobank at hospital admission with longitudinal follow-ups and non-burn controls aged 1 and 3 were collected from the ORIGINS cohort. Plasma lipid profiling and acute-phase glycoprotein systemic inflammatory markers (GlycA and GlycB) were quantified using metabolic phenotyping with hair cortisol provided as a longitudinal measure of stress. Lipidomic analysis revealed acute-phase disruptions in fatty acids and lysophospholipids in both sexes but only females demonstrated a persistent increase of arachidonic acid (FA 20:4) and depletion of monoacylglycerols more than a year post-injury. Females also had significantly higher acute-phase GlycA/GlycB levels around the time of injury and exhibited increasing variability in hair cortisol over time, while male burn survivors did not. These findings highlight a sex-specific response between lipid metabolism, systemic inflammation and stress in paediatric recovery from non-severe burns. Understanding these differences may guide the development of targeted psychological and physiological strategies to improve long-term outcomes for young burn survivors.