Scald burns in the neonate are rare in literature, especially major full-thickness injuries in newborns. However, burns are the third most common cause of accidental death among children in the United States. We hope that this report can provide us a new insight for guiding the timing of surgical treatment and the choice of the surgical scheme in severe burn neonates. In this case report, we demonstrate a case of a three-hour-old neonate, who suffered from severe scald burn injuries of 14% of the total body surface area (TBSA). Nearly two weeks after conservative treatment, the wounds showed no sign of healing. Escharotomy following skin grafting was done after the stabilization of the neonate. The neonate was discharged 32 days after injury. Through the review of this case report, we suggest we should pay attention to the following points. First, we should always pay attention to the blood supply of the extremities of the patient, and appropriately relax the indications for deep fasciotomy to reduce the disability rate. Secondly, we should pay special attention to the respiratory system of the newborn, especially for those after cesarean delivery. Moreover, the early application of broad-spectrum antibiotics should be conducted. Third, we should choose antibiotics with less hepatorenal toxicity, and adjust the dosage according to the body surface area of the neonate. Finally, skin grafting is an appropriate treatment and should be done as soon as possible.