The death toll in the Italian earthquake stands at 241 as thousands of rescuers continue efforts to find survivors.
Dozens are believed trapped in ruined Amatrice, Accumoli and Pescara del Tronto, in mountainous central Italy.
Rescuers have advised journalists and bystanders to leave Amatrice urgently, as "the town is crumbling", the BBC's Jenny Hill says.
New cracks appeared in the town's hospital after strong aftershocks.
Officials revised down the number of dead after earlier giving a figure of 247.
The search for survivors went on through the night, amid hundreds of tremors and an aftershock which rocked already damaged buildings.
More than 4,300 rescuers are using heavy lifting equipment and their bare hands.
Many of the victims were children, the health minister said, and there were warnings the toll could rise further.
Follow the latest developments here
Read the survivors' stories
The 6.2-magnitude quake hit at 03:36 (01:36 GMT) on Wednesday 100km (65 miles) north-east of Rome.
Some tremors after the quake were felt as far away as Rome.
"We are sleeping in the car and there were shocks all night. When the biggest one came, the car started moving and shaking," said Monica, a survivor from Amatrice.
A tented camp has been set up, as so many buildings are now unsafe.
The latest death toll was given on Thursday morning - 190 deaths in Rieti province and 57 in neighbouring Ascoli Piceno province.
Prime Minister Matteo Renzi was chairing an emergency cabinet meeting on Thursday. The agenda included reconstruction plans for the devastated area.
- Confusion and shock: Witnesses give their accounts
- Aerial shots of quake-hit Italy
- In pictures: before and after
- History of deadly earthquakes
- Can quakes be predicted?
Rescuers said they had pulled five bodies from the ruins of the Hotel Roma in Amatrice. As many as 70 tourists were staying at the hotel when the quake struck. Many are feared to be in the rubble, though several were pulled out and given medical care.
Many of those affected were Italians on holiday in the region. Some were in Amatrice for a festival to celebrate a famous local speciality - amatriciana bacon and tomato sauce.
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.
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 copyright ReutersThe mayor of Amatrice said three-quarters of the town had been destroyed and no building was safe for habitation.
The country is no stranger to earthquakes: the 2009 L'Aquila tremor killed more than 300 people and in May 2012 two tremors nine days apart killed more than 20 people in the northern Emilia Romagna region.
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.
Quakes 'ever present' for Italy's Apennines
Earthquakes that shook Italy
- 6 April 2009: A 5.8-magnitude earthquake struck L'Aquila in the Abruzzo region of central Italy, killing more than 300 people
- 23 November 1980: Southern Italy was rocked by a 6.9-magnitude quake with the Campania and Basilicata regions worst hit. More than 2,700 people were killed and almost 400,000 left homeless
- 23 July 1930: A quake measuring 6.5 hit Irpinia, a region of the southern Appenine Mountains about 40km east of Naples - 1,400 people died
- 28 December 1908: More than 80,000 died after a 7.2-magnitude quake, which devastated Sicily's second-largest city Messina and triggered a tsunami
Background: World's most devastating earthquakes
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