Objective To study the changes in serum autophagy markers in children with retinopathy of prematurity （ROP） and its clinical value. Methods Premature infants who were screened for ROP in our hospital from January 2020 to December 2022 were selected as the study subjects. Those screened out with ROP at 4?6 weeks of birth were assigned to the ROP group and those without ROP to the control group. The levels of serum autophagy markers LC3?Ⅱ， Beclin?1 and P62 were detected at the 3rd day， 1st， 2nd and 3rd weeks of birth. The two groups were compared in terms of serum autophagy markers. The diagnostic efficacy of serum autophagy markers on ROP was analyzed. Results There was no significant difference in serum LC3?Ⅱ， Beclin?1 and P62 levels between the ROP group and control group at the 3rd day of birth （P > 0.05）. At the first， second and third weeks of birth， however， the ROP group showed significantly lower levels of serum LC3?Ⅱ and Beclin?1 but higher level of P62 compared to the control group （both P < 0.05）. The levels of serum LC3?Ⅱ， Beclin?1 and P62 at the first， second and third weeks of birth had diagnostic value for ROP. The children in the ROP group who did not receive mechanical ventilation and oxygen inhalation， and did not develop with sepsis and bronchopulmonary dysplasia showed lower serum LC3?Ⅱ and Beclin?1 levels and higher P62 levels at the first， second and third weeks of birth compared to those without the above?mentioned treatment as well as those complications （all P < 0.05）. In the ROP group， those with severe ROP showed lower serum LC3?Ⅱ and Beclin?1 levels and higher P62 levels at the 3rd day， and 1st， 2nd and 3rd week of birth （all P < 0.05）. Conclusion The levels of serum autophagy markers in children with ROP show significant changes since the first week of birth， so they have diagnostic efficacy for the diseases.