Expert Opinion :
This child had jaundice from Day 3 of life with hepatosplenomegaly suggestive of neonatal hepatitis. Now the child seems to have decompensated for the past 3 days with fever and blood in stools. The child also has swelling over the left thigh for 2 days which may suggest a bleed. Thus, the child seems to have developed coagulopathy due to liver disease. Now the child is deeply icteric with decerebrate posturing suggestive of hepatic encephalopathy. The tense anterior fontanelle may either suggest an intraventricular bleed or meningitis. However, with liver disease and bleeding manifestations elsewhere, one may suspect intracranial bleed rather than infection. Thus lumbar puncture (LP) should be avoided and imaging should be done to rule out an intracranial bleed first. In this child, the child died after 4 hours, and post-mortem LP done showed blood in CSF confirming the diagnosis of intracranial bleed. Thus in a child with hepatic encephalopathy, coagulopathy is common and procedures that can lead to profuse bleeding such as arterial pricks (for ABG), etc should be avoided.