[4][5][6] The river enters Pamlico Sound just east of Maw Point Shoal near Hobucken, North Carolina while en route to the Atlantic Ocean.

[4][7] Typical of rivers in the Coastal Plain of North Carolina, the Neuse enters a basin of chocolate intermittent bottomland swamp on its journey towards its outlet.

One interesting exception is the "Cliffs of the Neuse" area near Goldsboro, where the river cuts a narrow 30 m (90 ft) gorge through limestone and sandstone bluffs.

The Neuse is prone to extremes in its flow carriage, often escaping its banks during wet periods, then reducing to a trickle that can be forded on foot during prolonged drought conditions.

In 1865 during the American Civil War, the Confederates burned one of the last ironclad warships which they had built, the Ram Neuse, to prevent its capture by Union troops.

[9] The low-head Quaker Neck Dam was built in 1952 at Neuse River kilometer 225 to impound cooling water for a steam electric plant.

[10] The Neuse has been plagued in recent years with environmental and public health problems related to municipal and agricultural waste water discharge, storm runoff, and other sources of pollution.