Objective To investigate the clinical features of gestational alloimmune liver disease-neonatal hemochromatosis (GALD-NH) and to provide differential diagnosis of neonatal liver failure.Method A preterm infant admitted in neonatal intensive care unit shortly after birth. He presented with persistent thrombocytopenia, severe coagulation disorder, hypoproteinemia, cholestasis and ascites. Specialists from Department of Radiology, Ultrasonography, and Stomatology were invited to discuss the case. The diagnosis and treatment were adjusted according to the result of discussion. Results The case was characterized by acute liver failure in the early life. After multi-disciplinary treatment, GALD-NH was considered as the most likely cause of liver failure. Although oral mucosa biopsy was negative, abdominal (liver, spleen, pancreas) MRI showed liver and spleen had hypointense on T2WI. Liver biopsy showed that pathologic siderosis in hepatocytes. The patient finally diagnosed as GALD-NH. Conclusion When neonate with liver failure, neonatal hemochromatosis should be considered in addition to infectious liver disease, obstructive liver disease and genetic metabolic disease.