The 6.2-magnitude quake hit at 03:36 (01:36 GMT) on Wednesday 100km (65 miles) north-east of Rome.
The latest death toll was given on Thursday morning - 190 deaths in Rieti province and 57 in neighbouring Ascoli Piceno province.
Image copyrightAPImage captionAmatrice: Most of the pretty historic town is now rubble, blanketed in grey dustImage copyrightREUTERSImage captionAmatrice residents spent the night outdoors
Rescuers said they had pulled five bodies from the ruins of the Hotel Roma in the historic town of Amatrice. Officials said about 35 people had been staying at the hotel and most had managed to get out. About 10 people were still unaccounted for, a local fire official said.
Late on Wednesday there were cheers in the village of Pescara del Tronto when a young girl was pulled alive from the rubble after being trapped for 17 hours. Almost all the houses there had collapsed, the mayor said.
The quake struck small towns and villages in the mountainous area where the regions of Umbria, Lazio and Le Marche meet.
People there spent the night outside or in tents provided by the emergency services.
Among the victims was an 18-month-old toddler, Marisol Piermarini, whose mother Martina Turco survived the deadly 2009 earthquake in L'Aquila and moved away from there after the experience, Italian news agency Ansa reported.
Ms Turco was being treated in hospital after being pulled from the rubble in the village of Arquata del Tronto, Ansa said.
Image copyrightREUTERSImage captionThe search for survivors continued overnightImage copyrightREUTERSImage captionAlmost all the houses in Pescara del Tronto collapsed
The area has also been shaken by strong aftershocks, including a 4.7-magnitude tremor with its epicentre about 7km east of Norcia, according to the US Geological Survey.
The mayor of Amatrice said three-quarters of the town had been destroyed and no building was safe for habitation.
Many of those affected were on holiday in the region. Some were in Amatrice for a festival to celebrate a famous local speciality - amatriciana bacon and tomato sauce.
Why is Italy at risk of earthquakes? By Jonathan Amos
Earthquakes are an ever-present danger for those who live along the Apennine mountain range in Italy.
Through the centuries thousands have died as a result of tremors equal to, or not much bigger than, the event that struck in the early hours of Wednesday. The modern response, thankfully, has been more robust building and better preparation.
Mediterranean seismicity is driven by the great collision between the African and Eurasian tectonic plates; but when it comes down to the specifics of this latest quake, the details are far more complicated.
The Tyrrhenian Basin, or Sea, which lies to the west of Italy, between the mainland and Sardinia/Corsica, is slowly opening up.
Scientists say this is contributing to extension, or "pull-apart", along the Apennines. This stress is compounded by movement in the east, in the Adriatic.
The result is a major fault system that runs the length of the mountain range with a series of smaller faults that fan off to the sides. The foundations of cities like Perugia and L'Aquila stand on top of it all.
Image copyrightGOOGLE/APImage captionThese pictures show the main street in Amatrice before and after the quakeImage copyrightGOOGLE/EPAImage captionThese images show the hamlet of Pescara del Tronto before and after
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