Hepatobiliary Disease USMLE Step 1 Practice Question

A 3-week-old male infant presents to the pediatric clinic with persistent jaundice. His mother reports that despite adequate feeding every 3-4 hours with good intake, the jaundice has worsened over the past 2 weeks. She also noticed his stools have become progressively pale and clay-colored, while his urine remains dark yellow. He was born at 39 weeks via uncomplicated vaginal delivery to a seronegative mother. On examination, vital signs are normal; scleral icterus and generalized jaundice are noted. Abdominal palpation reveals a firm, smooth hepatomegaly (3.5 cm below the right costal margin) without splenomegaly or ascites. Laboratory studies show: Total bilirubin 15.8 mg/dL, Direct bilirubin 14.1 mg/dL, AST 78 U/L, ALT 71 U/L, γ-glutamyl transferase 168 U/L (normal 5-50), albumin 3.8 g/dL, INR 1.1. Abdominal ultrasound shows patent hepatic vessels with normal gallbladder size. Which of the following is the most likely early complication if this condition remains untreated?