The quake struck at 3.30am (0130GMT) affecting 26 towns and cities within a 30km (20 mile) radius of L'Aquila, the epicentre.
At least 1,500 wounded people have received treatment.
Silvio Berlusconi, the prime minister, declared a national emergency and travelled to the region.
He said that 30 million euros ($40mn) would be provided to assist the disaster zone initially and that tents for between 16,000 and 20,000 people would be established.
Berlusconi also said that he would additionally seek finance from an EU disaster fund.
"It is a serious disaster. Now we must rebuild and that will require huge sums of money... No one will be abandoned to his fate," Berlusconi said.
Roberto Maroni, the interior minister, said an additional 1,7000 rescuers, including 1,500 firefighters, had been provided.
The majority of residents had left the region by Monday night, either of their own volition or after being escorted by the authorities.
"You can say that most of the old city has been emptied of its residents," a public safety official said, adding that it was mostly elderly people who decided to stay.
Using floodlights and bulldozers workers attempted to find survivors, some who had been trapped for more than 20 hours, through Monday night.
One boy was pulled alive from the rubble.
"All we could see was his head sticking from the rubble, his entire body was buried," one of the firemen who rescued him said.
"We kept digging, picking piece by piece of debris and we finally managed to get him out - when we did, the fatigue was great but so was our joy," he said.
Nazinine Moshiri, Al Jazeera's correspondent in L'Aquila, said: "Throughout the night and yesterday the priority really is to try to find survivors.
|Italy has pledged 30 million euros to
help the region [AFP]
"In the last 24 hours two people have been pulled out of the rubble, we believe that they were students. L'Aquila is a student town, there are student dormitories dotted around," she said.
"A student dormitory was really badly hit - a 12-storey building almost reduced to rubble. Students had to jump out of windows ... when the earthquake struck.
"We understand that there are still students alive in the rubble of one of the main dorms.
"Homes, even if they are standing, are not structurally safe to return to.
"But it was the elderly and many children who were unable to get out of their buildings and they make the bulk of victims."
Moshiri said that 250 people were believed to still be missing, and that individuals can be rescued days after an earthquake strikes, although hope in the region was diminishing.
"It is a battle against time for firefighters who are digging through the rubble, some by hand to get survivors."
"The problem is where are the survivors going to be homed in the coming weeks and months."
L'Aquila, where most of the dead are, has a population of 68,000 and lies about 100km northeast of Rome, the capital.
The neighbouring villages of Villa Sant'Angelo and Borgo di Castelnuovo were almost completely destroyed.